Making Fair Choices on the Path to Universal Health Coverage: Applying Principles to Difficult Cases

Abstract

one apply these principles in particular cases, and how should one adjudicate between them when their demands conflict? This article by some members of the Consultative Group and a diverse group of health policy professionals addresses these questions. It considers three stylized versions of actual policy dilemmas. Each of these cases pertains to one of the three key dimensions of progress toward UHC: which services to cover first, which populations to prioritize for coverage, and how to move from out-of-pocket expenditures to prepayment with pooling of funds. Our cases are simplified to highlight common trade-offs. Though we make specific recommendations, our primary aim is to demonstrate both the form and substance of the reasoning involved in striking a fair balance between competing interests on the road to UHC.

Health Financing Reforms for Moving towards Universal Health Coverage in the Western Pacific Region

“…For example, when designing benefits, cost-effectiveness is used as one of the major factors in the priority setting of interventions; however, there are several additional factors involved, such as social, equitable, ethical, legal, political, budget impact, and implementation considerations. 50,51 It is also important that vulnerable populations are factored into the prioritization process. This goes beyond health technology assessment and is critical in maintaining accountability of decision makers and health managers for how funds are spent.…”

Why Health-Related Inequalities Matter and Which Ones Do

“…The relevant values are difficult to balance against each other; moreover, the quality of the information available on the interventions' impact will often be limited. Priority setting will therefore always require deliberation and educated judgment (Voorhoeve et al 2017). What is crucial, however, is that mechanisms are put in place to ensure that the diverse egalitarian values outlined here are always taken into account.…”

Feszültségek és kompromisszumkényszer a 21. századi egészségügyben

“…A 21. századi eü feszültségei (lásd: a gazdasági és morális elv) oldása érdekében társadalmi kompromisszumot kell kötni, amelynek döntő eleme a prioritási elvek megfogalmazása (WHO, 2014;Rumbold et al, 2017;Voorhoeve et al, 2017). A prioritálás szükségességének -az orvosi beavatkozások, a rászorultság sorrendbe rendezése, az elsőbbségi szempontok érvényesítése -társadalmi szintű elfogadtatásában az lehet az érv, hogy csak így lehet érvényesíteni minden ember számára az alanyi jogon neki járó egészségügyi ellátást.…”