Health Care Coverage Decision Making in Low- and Middle-Income Countries: Experiences from 25 Coverage Schemes.
Lessons learned by countries that have successfully implemented coverage schemes for health services may be valuable for other countries, especially low- and middle-income countries (LMICs), which likewise are seeking to provide/expand coverage. The research team surveyed experts in population health management from LMICs for information on characteristics of health care coverage schemes and factors that influenced decision-making processes. The level of coverage provided by the different schemes varied. Nearly all the health care coverage schemes involved various representatives and stakeholders in their decision-making processes. Maternal and child health, cardiovascular diseases, cancer, and HIV were among the highest priorities guiding coverage development decisions. Evidence used to inform coverage decisions included medical literature, regional and global epidemiology, and coverage policies of other coverage schemes. Funding was the most commonly reported reason for restricting coverage. This exploratory study provides an overview of health care coverage schemes from participating LMICs and contributes to the scarce evidence base on coverage decision making. Sharing knowledge and experiences among LMICs can support efforts to establish systems for accessible, affordable, and equitable health care.
1 Cedar Associates LLC , Menlo Park, California.|2 Mailman School of Public Health, Columbia University , New York, New York.
Hialy
H
Gutierrez
1 Cedar Associates LLC , Menlo Park, California.
Ashwini
A
Shewade
1 Cedar Associates LLC , Menlo Park, California.
Minghan
M
Dai
3 Jorge Basadre Headquarters, National Major University of San Marcos , Lima, Peru .
Pedro
P
Mendoza-Arana
4 National Institute of Public Health , Cuernavaca, Mexico .
Octavio
O
Gómez-Dantés
5 Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH , New Delhi, India .
Nishant
N
Jain
6 Centers for Disease Control and Prevention , Atlanta, Georgia .
Irma
I
Khonelidze
7 Health Systems and Services Cluster, WHO Uganda Country Office , Kampala, Uganda .
Juliet
J
Nabyonga-Orem
8 World Bank , Washington, DC.
Karima
K
Saleh
9 International Health Policy Program, Ministry of Public Health , Nonthaburi, Thailand .
Yot
Y
Teerawattananon
10 Heartfile , Islamabad, Pakistan .
Sania
S
Nishtar
1 Cedar Associates LLC , Menlo Park, California.|11 Stanford University School of Medicine , Stanford, California.
John
J
Hornberger
D003657:Decision Making; D003906:Developing Countries; D018166:Health Care Reform / Q000191:economics*; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D011203:Poverty / Q000191:economics*; D020414:Risk Sharing, Financial; D019472:Universal Health Insurance / Q000191:economics*