Progressive Realisation of Universal Health Coverage: What Are the Required Processes and Evidence?

BMJ global health, 2(3) (2017)

7 Pages Posted: 29 Mar 2021

See all articles by Rob Baltussen

Rob Baltussen

Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands

Maarten P. Jansen

Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands

Leon Bijlmakers

Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands

Noor Tromp

Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands

Alicia Ely Yamin

Harvard University - Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics; Harvard University - Harvard Law School; Partners in Health; Chr. Michelsen Institute (CMI) - Center on Law and Social Transformation

Ole Frithjof Norheim

University of Bergen

Date Written: August 22, 2017

Abstract

Progressive realisation is invoked as the guiding principle for countries on their own path to universal health coverage (UHC). It refers to the governmental obligations to immediately and progressively move towards the full realisation of UHC. This paper provides procedural guidance for countries, that is, how they can best organise their processes and evidence collection to make decisions on what services to provide first under progressive realisation. We thereby use ‘evidence-informed deliberative processes’, a generic value assessment framework to guide decision making on the choice of health services. We apply this to the concept of progressive realisation of UHC. We reason that countries face two important choices to achieve UHC. First, they need to define which services they consider as high priority, on the basis of their social values, including cost-effectiveness, priority to the worse off and financial risk protection. Second, they need to make tough choices whether they should first include more priority services, first expand coverage of existing priority services or first reduce co-payments of existing priority services. Evidence informed deliberative processes can facilitate these choices for UHC, and are also essential to the progressive realisation of the right to health. The framework informs health authorities on how they can best organise their processes in terms of composition of an appraisal committee including stakeholders, of decision- making criteria, collection of evidence and development of recommendations, including their communication. In conclusion, this paper fills in an important gap in the literature by providing procedural guidance for countries to progressively realise UHC.

Suggested Citation

Baltussen, Rob and Jansen, Maarten P. and Bijlmakers, Leon and Tromp, Noor and Yamin, Alicia Ely and Norheim, Ole Frithjof, Progressive Realisation of Universal Health Coverage: What Are the Required Processes and Evidence? (August 22, 2017). BMJ global health, 2(3) (2017), Available at SSRN: https://ssrn.com/abstract=3795555

Rob Baltussen (Contact Author)

Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands ( email )

Geert Grooteplein Zuid 10
Nijmegen
Netherlands

Maarten P. Jansen

Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands ( email )

Geert Grooteplein Zuid 10
Nijmegen
Netherlands

Leon Bijlmakers

Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands ( email )

Geert Grooteplein Zuid 10
Nijmegen
Netherlands

Noor Tromp

Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands ( email )

Geert Grooteplein Zuid 10
Nijmegen
Netherlands

Alicia Ely Yamin

Harvard University - Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics ( email )

23 Everett Street
Cambridge, MA 02155
United States

Harvard University - Harvard Law School ( email )

1563 Massachusetts Avenue
Cambridge, MA 02138
United States

Partners in Health ( email )

641 Huntington Ave, 1st Floor
Boston, MA 02115
United States

Chr. Michelsen Institute (CMI) - Center on Law and Social Transformation ( email )

PO Box 6033 Postterminalen
Bergen, NO-5892
Norway

Ole Frithjof Norheim

University of Bergen ( email )

Muséplassen 1
N-5008 Bergen, +47 55 58
Norway

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