Economic analysis for health benefits package design

A health benefits package (HBP) defines the list of publicly provided health services offered by a country’s health system. HBPs are seen as an important component toward achieving universal health coverage in low- and middle-income countries. This paper provides an overview of the main considerations that arise when designing and implementing an HBP. The first set of issues relate to the governance of HBPs. The processes for designing and updating the HBP should be transparent, consistent, stable and involve consultation with appropriate stakeholders. These features can improve public support for the HBP by making decision-makers accountable for choices and the HBP process understandable to citizens. Economic considerations are also paramount when selecting interventions to include in an HBP. The value of interventions can be judged on multiple criteria that reflect the various objectives of a specific health system. Economic evaluation methods, such as cost-effectiveness analysis (CEA), can be used to generate evidence on outcomes and costs to help decision makers select a package in pursuit of a common health system objective: improving population health. This can yield the list of interventions and the optimal size of the HBP budget that maximise health outcomes. Economic evaluation methods can also be used to consider how additional health system constraints and objectives can affect decisions around an HBP. These include commitments to principles of equity, limited supply of human resources and equipment, and low levels of implementation.