Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 May;8(Suppl 1):e010755.
doi: 10.1136/bmjgh-2022-010755.

From Universal Health Coverage services packages to budget appropriation: the long journey to implementation

Agnès Soucat  1 , Ajay Tandon  2 , Eduardo Gonzales Pier  3
Affiliations
Review

From Universal Health Coverage services packages to budget appropriation: the long journey to implementation

Agnès Soucat et al. BMJ Glob Health. 2023 May.

Abstract

Essential packages of health services (EPHS) potentially contribute to universal health coverage (UHC) financing through several pathways. Generally, expectations on what an EPHS can achieve for health financing are high, yet stakeholders rarely spell out mechanisms to reach desired outcomes. This paper analyses how EPHS relate to the three health financing functions (revenue raising, risk pooling and purchasing) and to public financial management (PFM). Our review of country experiences found that using EPHS to directly leverage funds for health has rarely been effective. Indirectly, EPHS can translate into increased revenue through fiscal measures, including health taxes. Through improved dialogue with public finance authorities, health policy-makers can use EPHS or health benefit packages to communicate the value of additional public spending connected with UHC indicators. Overall, however, empirical evidence on EPHS contribution to resource mobilisation is still pending. EPHS development exercises have been more successful in advancing resource pooling across different schemes: EPHS can help comparing performance of coverage schemes, occasionally leading to harmonisation of UHC interventions and identifying gaps between health financing and service delivery. EPHS development and iterative revisions play an essential role in core strategic purchasing activities as countries develop their health technology assessment capacity. Ultimately, packages need to translate into adequate public financing appropriations through country health programme design, ensuring funding flows directly address obstacles to increased coverage.

Keywords: Health economics; Health policies and all other topics; Health policy; Health services research; Health systems.

PubMed Disclaimer

Conflict of interest statement

Competing interests: This paper is part of a series of seven papers to be published as a supplement coordinated by the DCP3 Country Translation project at the LSHTM, which is funded by the Bill & Melinda Gates Foundation.

Figures

Figure 1
Figure 1. The link between EPHS and health finance policy objectives. EPHS, essential packages of health services.
Figure A
Figure A. Evolution of public spending 2015–2019 in four countries.
Figure 2
Figure 2. Drivers of public financing for health by macrofiscal determinants (left panel) and by fiscal source (right panel), 2000–2019. SHI, social health insurance.
Figure 3
Figure 3. Crowding out government spending on health from domestic sources in aid-dependent countries (external health aid and government domestic health spending), 2005–2019.
Figure 4
Figure 4. Public expenditure in health for India and China 2000–2019.
See this image and copyright information in PMC

References

    1. World Health Organization . Public spending on health: a closer look at global trends. Geneva: World Health Organization; 2018.
    1. Cotlear D, Nagpal S, Smith O, et al. Going universal: how 24 developing countries are implementing universal health coverage from the bottom up. Washington, DC: World Bank Group; Sep 28, 2015. - DOI
    1. Glassman A, Giedion U, Smith PC. What’s in, what’s out: designing benefits for universal health coverage. Washington DC: Center for Global Development; 2017.
    1. Glassman A, Giedion U, Sakuma Y, et al. Defining a health benefits package: what are the necessary processes? Health Systems & Reform. 2016;2:39–50. doi: 10.1080/23288604.2016.1124171. - DOI - PubMed
    1. Ben Mesmia H, Chtioui R, Ben Rejeb M. The tunisian societal dialogue for health reform (a qualitative study) European Journal of Public Health. 2020;30(Supplement_5) doi: 10.1093/eurpub/ckaa166.1393. - DOI

Publication types

LinkOut - more resources