What's In, What's Out: Designing Benefits for Universal Health Coverage

Ursula Giedion
Peter C. Smith
July 03, 2017

“Resources are always finite—the evidence-based, fair, transparent, and accountable benefits package is the most important tool to justify the use of finite resources to achieve real universal health coverage.”

—Suwit Wibulpolprasert, Ministry of Public Health, Thailand

“This book addresses an important concern: which services can we provide and which can we not, given limited health resources? Because the answer is context-dependent, we need principles and methods for deciding what we should and should not cover with public monies.”

—Wei Fu, Director General, China National Health and Development Research Center

“One of the big challenges for universal health coverage in Latin America and the Caribbean is the difference between what is being promised and what is actually delivered, what people may expect and what they actually get. Health benefits packages, by making explicit what is implicit, become critically important in this context."

—Adolfo Rubinstein, Founder and Director General, Institute of Clinical Effectiveness and Health Policy (IECS)


Vaccinate children against deadly pneumococcal disease, or pay for cardiac patients to undergo lifesaving surgery? Cover the costs of dialysis for kidney patients, or channel the money toward preventing the conditions that lead to renal failure in the first place? Policymakers dealing with the realities of limited health care budgets face tough decisions like these regularly. And for many individuals, their personal healthcare choices are equally stark: paying for medical treatment could push them into poverty.

Many low- and middle-income countries now aspire to universal health coverage, where governments ensure that all people have access to the quality health services they need without risk of impoverishment. But for universal health coverage to become reality, the health services offered must be consistent with the funds available—and this implies tough everyday choices for policymakers that could be the difference between life and death for those affected by any given condition or disease. The situation is particularly acute in low- and middle income countries where public spending on health is on the rise but still extremely low, and where demand for expanded services is growing rapidly.

What’s In, What’s Out: Designing Benefits for Universal Health Coverage argues that the creation of an explicit health benefits plan—a defined list of services that are and are not available—is an essential element in creating a sustainable system of universal health coverage. With contributions from leading health economists and policy experts, the book considers the many dimensions of governance, institutions, methods, political economy, and ethics that are needed to decide what’s in and what’s out in a way that is fair, evidence-based, and sustainable over time.

In March 2017, we hosted a workshop on defining and updating health benefits packages for universal health coverage with participants from seven sub-Saharan African countries, Indonesia, Thailand, and China, as a final input to the book. You can view the materials from the workshop here.


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