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Using allocative efficiency analysis to inform health benefits package design for progressing towards Universal Health Coverage: Proof-of-concept studies in countries seeking decision support

Author

Listed:
  • Nicole Fraser-Hurt
  • Xiaohui Hou
  • Thomas Wilkinson
  • Denizhan Duran
  • Gerard J Abou Jaoude
  • Jolene Skordis
  • Adanna Chukwuma
  • Christine Lao Pena
  • Opope O Tshivuila Matala
  • Marelize Gorgens
  • David P Wilson

Abstract

Background: Countries are increasingly defining health benefits packages (HBPs) as a way of progressing towards Universal Health Coverage (UHC). Resources for health are commonly constrained, so it is imperative to allocate funds as efficiently as possible. We conducted allocative efficiency analyses using the Health Interventions Prioritization tool (HIPtool) to estimate the cost and impact of potential HBPs in three countries. These analyses explore the usefulness of allocative efficiency analysis and HIPtool in particular, in contributing to priority setting discussions. Methods and findings: HIPtool is an open-access and open-source allocative efficiency modelling tool. It is preloaded with publicly available data, including data on the 218 cost-effective interventions comprising the Essential UHC package identified in the 3rd Edition of Disease Control Priorities, and global burden of disease data from the Institute for Health Metrics and Evaluation. For these analyses, the data were adapted to the health systems of Armenia, Côte d’Ivoire and Zimbabwe. Local data replaced global data where possible. Optimized resource allocations were then estimated using the optimization algorithm. In Armenia, optimized spending on UHC interventions could avert 26% more disability-adjusted life years (DALYs), but even highly cost-effective interventions are not funded without an increase in the current health budget. In Côte d’Ivoire, surgical interventions, maternal and child health and health promotion interventions are scaled up under optimized spending with an estimated 22% increase in DALYs averted–mostly at the primary care level. In Zimbabwe, the estimated gain was even higher at 49% of additional DALYs averted through optimized spending. Conclusions: HIPtool applications can assist discussions around spending prioritization, HBP design and primary health care transformation. The analyses provided actionable policy recommendations regarding spending allocations across specific delivery platforms, disease programs and interventions. Resource constraints exacerbated by the COVID-19 pandemic increase the need for formal planning of resource allocation to maximize health benefits.

Suggested Citation

  • Nicole Fraser-Hurt & Xiaohui Hou & Thomas Wilkinson & Denizhan Duran & Gerard J Abou Jaoude & Jolene Skordis & Adanna Chukwuma & Christine Lao Pena & Opope O Tshivuila Matala & Marelize Gorgens & Davi, 2021. "Using allocative efficiency analysis to inform health benefits package design for progressing towards Universal Health Coverage: Proof-of-concept studies in countries seeking decision support," PLOS ONE, Public Library of Science, vol. 16(11), pages 1-21, November.
  • Handle: RePEc:plo:pone00:0260247
    DOI: 10.1371/journal.pone.0260247
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    References listed on IDEAS

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    1. World Bank, 2017. "Analyzing Fiscal Space Options for Health in Zimbabwe," World Bank Publications - Reports 26410, The World Bank Group.
    2. Amanda Glassman & Kalipso Chalkidou, 2012. "Priority-Setting in Health: Building Institutions for Smarter Public Spending," Working Papers id:5043, eSocialSciences.
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