Abstract
Universal Health Coverage (UHC) has become a key goal of health policy in many developing countries. However, implementing UHC poses tough policy choices about: what treatments to provide (the depth of coverage); to what proportion of the population (the breadth of coverage); at what price to patients (the height of coverage). This paper uses a theoretical mathematical programming model to derive analytically the optimal balance between the range of services provided and the proportion of the population covered under UHC, using the general principles of cost-effectiveness analysis. In contrast to most CEA, the model allows for variations in both the costs of provision and the social benefits of treatments, depending on the deprivation level of the population. We illustrate empirically the optimal trade-off between the size of the benefits package and the proportion of the population securing access to each treatment for a hypothetical East African country, based on WHO data on the costs and benefits of treatments at different coverage levels. We begin with a scenario allowing coverage levels to vary, then apply differential equity weights to the benefits of coverage, and finally illustrate a scenario where interventions are either provided at 95% coverage or not at all (as is usually done in health benefits package design) for comparison. The results present the optimal trade-off between the social benefits of pursuing full population coverage, at the expense of expanding the benefits package for ‘easier to reach’ populations.
Highlights
In many low- and middle-income countries (LMICs) recent debates about health policy have focused on the notion of Universal Health Coverage (UHC)
When differential equity weights are applied to the benefits of coverage 13 interventions are included and there is less variation in the levels at which they are covered: ten are fully covered at 100% and the remaining three are included at 65%, 58% and 75%
It is based on a theoretical mathematical programme that seeks to reconcile the concepts of depth and breadth coverage, as expressed in the WHO universal health coverage ‘cube’
Summary
In many low- and middle-income countries (LMICs) recent debates about health policy have focused on the notion of Universal Health Coverage (UHC). This is defined by the World Health Organization as “ensuring that all people can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while ensuring that the use of these services does not expose the user to financial hardship” (WHO, 2018). A fundamental principle of UHC is that it should be funded by government or quasi-government sources (such as mandatory social health insurance or donor funds) (Nicholson et al, 2015). We do not discuss further the nature of the funding pool, but for this paper assume it is exogenously fixed for a given period by the government or an analogous national decision-making body
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