Should Countries Set an Explicit Health Benefits Package? The Case of the English National Health Service

• Published in: Value in health 2017-01, Vol.20 (1), p.60-66
• Main Authors: Smith, Peter C, MA, Chalkidou, Kalipso, PhD
• Format: Article
• Language: English
• Subjects: Clinical practice guidelines; Clinical Protocols - standards; Compulsions; Cost analysis; Cost-Benefit Analysis; cost-effectiveness analysis; Delivery of Health Care - economics; Delivery of Health Care - organization & administration; Delivery of Health Care - standards; Drugs; health benefits package; Health care; Health care expenditures; Health Care Rationing - organization & administration; Health services; Historical perspectives; Humans; Incentives; Insurance coverage; Intelligence; Internal Medicine; Official documents; Patients; Practice Guidelines as Topic; Reimbursement, Incentive - organization & administration; Specification; State Medicine - economics; State Medicine - organization & administration; Treatment preferences; United Kingdom; universal health coverage
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2016.01.004

Abstract Background A fundamental debate in the transition towards universal health coverage concerns whether to establish an explicit health benefits package to which all citizens are entitled, and the level of detail in which to specify that package. At one extreme, the treatments to be funded, and the circumstances in which patients qualify for the treatment, might be specified in great detail, and be entirely mandatory. This would make clinicians little more than automata, carrying out prescribed practice. At the other extreme, priorities may be expressed in very broad terms, with no compulsion or other incentives to encourage adherence. Objectives The paper examines the arguments for and against setting an explicit benefits package, and discusses the circumstances in which increased detail in specification are most appropriate. Methods The English National Health Service is used as a case study, based on institutional history, official documents and research literature. Results Although the English NHS does not explicitly specify a health benefits package, it is in some respects establishing an ‘intelligent’ package, based on instruments such as an essential medicines list, clinical guidelines, provider payment and performance reporting, which acknowledges gaps in evidence and variations in local resource constraints. Conclusions Further moves towards a more explicit specification are likely to yield substantial benefits in most health systems. Considerations in determining the ‘hardness’ of benefits package specification might include the quality of information about the costs and benefits of treatments, the heterogeneity of patient needs and preferences, the financing regime in place, and the nature of supply side constraints.