Universal Health Coverage Won’t Happen Tomorrow, but Here Are Some Priority-Setting Tools to Help

Countries moving towards universal health coverage (UHC) face challenging decisions about what benefits they will include and cover—especially in the current fiscal and economic climate. Countries need easy-to-use and comprehensive tools to help them think through the path to expand (or contract) benefits for their country. In a new policy paper, akin to a Consumer Reports , we provide a framework for designing a benefits package and review selected tools for benefit package expansion.

A critical push for UHC through Health Technology Assessment

This month, the president of the UN General Assembly will hold a multistakeholder hearing on UHC, and Japan—a major proponent and advocate for UHC—will host and chair the G7 Leaders’ Summit. This fall, the 2023 United Nations High-Level Meeting on UHC will further mark UHC’s place on the global stage.

The emphasis on UHC is not only timely but also crucial. As the COVID-19 pandemic continues to ravage the world, the need for accessible and affordable healthcare has become unmistakably apparent. The pandemic has highlighted the inadequacies of healthcare systems worldwide and their inability to cope with the demands of a global health crisis. The push for UHC is, therefore, more pressing than ever before.

Achieving UHC requires more than just rhetoric; it requires concrete action. Tasked with guiding the allocation of resources to ensure that healthcare systems are sustainable, effective, and efficient, priority-setting institutions help to develop these tangible solutions. Priority-setting institutions are necessary to create a benefits package that covers essential healthcare services while remaining financially sustainable.

Through the adoption of Resolution 67.23 in 2014, the World Health Organization (WHO) recognized the importance of Health Technology Assessment (HTA), a key tool of priority-setting institutions, in achieving UHC. The resolution emphasizes HTA’s significance as an essential tool for decision-making in the implementation of UHC, calling on member states to strengthen their HTA capacity and to promote the use of HTA in decision-making processes. This resolution further underscores the need for priority-setting institutions to guide resource allocation decisions and ensure that essential healthcare services are accessible and affordable.

The Center for Global Development published a landmark report on priority-setting in 2012 led by Amanda Glassman and Kalipso Chalkidou, which led to the creation of the International Decision Support Initiative (iDSI) network. The report specifically recommended the establishment of a global HTA institution or agency to guide priority-setting and resource allocation decisions. iDSI became that institution, providing valuable guidance to low- and middle-income countries.

Choosing the right tool to expand the benefits package

More than ever before, priority-setting and designing benefit packages needs to be part of the UHC agenda. There are various approaches to making this happen. While vertical disease-specific programs have been the norm in global health for the past two decades, countries need to move towards a horizontal integrated approach to address multiple health concerns. In particular, a diagonal approach emphasizes the identification of cost-effective interventions that can be added incrementally to the benefits package.

Today we’re excited to release our new policy paper, which makes a small contribution to this huge body of work and scholarship. Doing HTA not only requires institutions and resources, but also tools. While tools do not replace institutions or resources, tools can support decision-making about what to add to national health benefit packages.

There are several tools available to local policymakers, but selecting the right tool is not easy. Like shopping for a car, each “car” or tool has its own features and specifications, but figuring out which tool is most suitable for a local policymaker is less apparent.

Our paper seeks to help local policymakers decide which tool to use. First, we explain the three common approaches used by countries to expand the benefits package. Next, we introduce a new framework: the IOM framework, organized in three layers: Inner Core, Outer Core, and Mantle. The IOM framework outlines features for policymakers to consider when creating a tool for benefit package expansion planning. We then use a design thinking approach to think through what features the tool should have in order to be useful. Finally, we implement a Pugh method to compare four priority-setting tools: WHO UHC Compendium, Optima, HIPtool, and OneHealth.

We conclude that, of the four tools reviewed, HIPtool was rated well in terms of the Mantle specifications of user accessibility, whereas the OneHealth tool rated well in terms of information on intervention costs and benefits. While some tools may be more sophisticated in their functionality (Optima, OneHealth), these tools were not rated well in terms of other design specifications. The WHO UHC Compendium, while having depth and breadth in its listed interventions, serves more as an essential list, but has great potential if it were to be customizable by users.

Notably, the nomenclature and taxonomy of interventions across tools varies greatly, and may cause confusion for nontechnical users. However, all tools can support decision-making processes and can be complementary to priority-setting institutions which have the capacity to help translate benefits into practice through implementation.

UHC is showing up in big ways on the global agenda this year. However, achieving UHC requires feasible and reasonable actions, including the establishment of priority-setting institutions that guide resource allocation decisions. Health benefit tools is one critical step to assisting in the process of benefit package expansion.


CGD blog posts reflect the views of the authors, drawing on prior research and experience in their areas of expertise. CGD is a nonpartisan, independent organization and does not take institutional positions.

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