Table 1.
Overview of analytical framework
| Institutional design aspect | Related policy choices | Intermediate output Indicators | UHC progress indicators |
|---|---|---|---|
| Eligibility and enrolment rules | |||
| Groups eligible for exemption from contributions/subsidization | Definition of vulnerability (e.g. low income, poverty, informal sector, children, pregnant women) | Share of eligible among the bottom two income quintiles and other vulnerable groups | Total population coverage (i.e. enrolment in health insurancefund), differentiated along income quintiles |
| Targeting method | E.g. universal (based on a very broad criterion such as residence or no employment in the formal sector), indirect (based on socio-demographic, socio-economic or geographic characteristics usually correlated with poverty and vulnerability), direct (through a means assessment or proxy means testing); different targeting approaches can be in place at the same time for different groups | Share of the exempted/subsidized within total (insured) population; share of the exempted/subsidized among those being targeted for exemption/subsidization (targeting effectiveness of the system), Income groups exempted/subsidized | |
| Enrolment process | Active enrolment by the beneficiary or automatic enrolment by the authorities | ||
| Type of membership of the exempted/subsidized | Voluntary or mandatory | ||
| Organization responsible for identification | E.g. insurance company; central, regional, local government | ||
| Financial arrangements | |||
| Degree of subsidization/co-contribution | Full or partial (a co-contribution is required) | Share of the exempted/subsidized within total (insured) population; share of the exempted/subsidized among those being targeted for exemption/subsidization (importance of budget transfers) | |
| Type of transfer logic | Individual-based (a specific amount is being paid for each exempted individual) or lump-sum (a lump sum transfer for the entire population is made) | ||
| Calculation logic to determine the amount of funds to be transferred | E.g. based on regular contribution levels, minimum or average wages, specific percentage of the government budget, negotiated by the government | ||
| Financing source of the budget transfers | E.g. general government revenues from central or sub-national levels, earmarked government revenues, transfers from other health insurance funds (cross-subsidization), donor funding | Sufficient funding for a comprehensive benefit package Level of cross-subsidization from contributions |
Financial protection (incidence of catastrophic/impoverishing health expenditure) a; Access to services |
| Pooling arrangements | |||
| Type of pool(s) (general) | Single pool or multiple pools | Degree of fragmentation, Size and composition of pools, Level of cross-subsidization |
Equity in access, Equity in financing, |
| Type of pool (exempted/subsidized) | Exempted/subsidized integrated in the pool with contributors, or separate pool for the exempted/subsidized | ||
| Type of health insurance affiliation membership of the contributors | Voluntary or mandatory | Financial protection | |
| Purchasing arrangements and benefit package design | |||
| Range of services covered by the benefit package | E.g. comprehensive, in-patient focus, out-patient focus, pharmaceuticals, dental care, indirect costs (e.g. transportation) | Financial protection, Access (utilization rates), Equity in access |
|
| Different or same package as that for contributors | Efficiency | ||
| Degree of cost-sharing | Cost-sharing mechanisms (e.g. co-insurance, co-payment, deductible) and rates | ||
| Provider-payment mechanisms | Type of payment and rate | ||
aCatastrophic health expenditure occurs when a household’s total out-of-pocket health payments equal or exceed 40 % of the household’s non-subsistence spending, as per the WHO definition. Impoverishing health expenditure means that out of pocket expenditure shifts a household below the poverty line or even deeper into poverty [23]