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Designing a Framework for Benefit Packages
Development of an essential health package requires explicit prioritisation on the basis of a country’s characteristics. A practical framework is presented to determine an EHP, considering coverage and equity perspectives for service delivery, financial protection and morbidity burden in the population. An analysis of morbidity data, unmet need for treatment, and impoverishment due to out-of-pocket spending reveals that a significant reduction in oop expenditure and impoverishment is possible through targeted inclusion of potentially high impoverishment-causing morbidities in EHPs. Such an approach may offer the desired flexibility in decision-making to policymakers, without compromising on benefits transferred to the needy.
Essential health packages (EHPs) are increasingly seen by countries as a guaranteed set of minimum services for its population (Kieny and Evans 2013). The interest in EHPs deepened with the resolution on universal health coverage (UHC) adopted by the 58th World Health Assembly in 2005 (WHO 2005). Since resources are finite, one needs to define “universal” carefully, and the specifics of what goes into a package could vary from country to country. The concept of UHC is not new in the context of Indian health policy discourse. Way back in 1946, the Health Survey and Development Committee (1946) in its report, aspired to achieve the provision of essential health services for the entire population with an equitable focus. India began its first series of architectural reforms in the health sector, indirectly moving towards UHC, with the launch of the National Rural Health Mission (NRHM, now called National Health Mission) in 2005 (Reddy 2015).
However, it was much more focused towards the universal provision of selected healthcare services for targeted population groups—such as preventive care and institutional delivery for pregnant women, treatment for children and adolescents for selected deficiencies, congenital disorders, disabilities and childhood diseases. This was followed by the launch of some publicly financed health insurance schemes (PFHIS)—funded by the central and state governments—targeted towards below poverty line population and those working in the unorganised sector (Virk and Atun 2015). The High Level Expert Group (2011) on UHC constituted by the Planning Commission of India recommended the prioritisation of primary healthcare, and at the same time the development of an EHP that would include essential services at all levels of care.
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