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Squaring the cube: Towards an operational model of optimal universal health coverage

Universal Health Coverage (UHC) has become a key goal of health policy in many developing countries. However, implementing UHC poses tough policy choices about: what treatments to provide (the depth of coverage); to what proportion of the population (the breadth of coverage); at what price to patien...

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Detalles Bibliográficos
Autores principales: Ochalek, Jessica, Manthalu, Gerald, Smith, Peter C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier North Holland 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7188249/
https://www.ncbi.nlm.nih.gov/pubmed/31955865
http://dx.doi.org/10.1016/j.jhealeco.2019.102282
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author Ochalek, Jessica
Manthalu, Gerald
Smith, Peter C.
author_facet Ochalek, Jessica
Manthalu, Gerald
Smith, Peter C.
author_sort Ochalek, Jessica
collection PubMed
description Universal Health Coverage (UHC) has become a key goal of health policy in many developing countries. However, implementing UHC poses tough policy choices about: what treatments to provide (the depth of coverage); to what proportion of the population (the breadth of coverage); at what price to patients (the height of coverage). This paper uses a theoretical mathematical programming model to derive analytically the optimal balance between the range of services provided and the proportion of the population covered under UHC, using the general principles of cost-effectiveness analysis. In contrast to most CEA, the model allows for variations in both the costs of provision and the social benefits of treatments, depending on the deprivation level of the population. We illustrate empirically the optimal trade-off between the size of the benefits package and the proportion of the population securing access to each treatment for a hypothetical East African country, based on WHO data on the costs and benefits of treatments at different coverage levels. We begin with a scenario allowing coverage levels to vary, then apply differential equity weights to the benefits of coverage, and finally illustrate a scenario where interventions are either provided at 95% coverage or not at all (as is usually done in health benefits package design) for comparison. The results present the optimal trade-off between the social benefits of pursuing full population coverage, at the expense of expanding the benefits package for ‘easier to reach’ populations.
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spelling pubmed-71882492020-05-04 Squaring the cube: Towards an operational model of optimal universal health coverage Ochalek, Jessica Manthalu, Gerald Smith, Peter C. J Health Econ Article Universal Health Coverage (UHC) has become a key goal of health policy in many developing countries. However, implementing UHC poses tough policy choices about: what treatments to provide (the depth of coverage); to what proportion of the population (the breadth of coverage); at what price to patients (the height of coverage). This paper uses a theoretical mathematical programming model to derive analytically the optimal balance between the range of services provided and the proportion of the population covered under UHC, using the general principles of cost-effectiveness analysis. In contrast to most CEA, the model allows for variations in both the costs of provision and the social benefits of treatments, depending on the deprivation level of the population. We illustrate empirically the optimal trade-off between the size of the benefits package and the proportion of the population securing access to each treatment for a hypothetical East African country, based on WHO data on the costs and benefits of treatments at different coverage levels. We begin with a scenario allowing coverage levels to vary, then apply differential equity weights to the benefits of coverage, and finally illustrate a scenario where interventions are either provided at 95% coverage or not at all (as is usually done in health benefits package design) for comparison. The results present the optimal trade-off between the social benefits of pursuing full population coverage, at the expense of expanding the benefits package for ‘easier to reach’ populations. Elsevier North Holland 2020-03 /pmc/articles/PMC7188249/ /pubmed/31955865 http://dx.doi.org/10.1016/j.jhealeco.2019.102282 Text en © 2020 The Authors http://creativecommons.org/licenses/by/4.0/ This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Ochalek, Jessica
Manthalu, Gerald
Smith, Peter C.
Squaring the cube: Towards an operational model of optimal universal health coverage
title Squaring the cube: Towards an operational model of optimal universal health coverage
title_full Squaring the cube: Towards an operational model of optimal universal health coverage
title_fullStr Squaring the cube: Towards an operational model of optimal universal health coverage
title_full_unstemmed Squaring the cube: Towards an operational model of optimal universal health coverage
title_short Squaring the cube: Towards an operational model of optimal universal health coverage
title_sort squaring the cube: towards an operational model of optimal universal health coverage
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7188249/
https://www.ncbi.nlm.nih.gov/pubmed/31955865
http://dx.doi.org/10.1016/j.jhealeco.2019.102282
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