Table 7.

Benefit package design

Country	Scope of benefit package
	Services covered	Compared to regularly insured population
Cambodia:
HEFs	District referral hospital medical services, transport costs from health centre to referral hospital, food for patients and carers, sometimes funeral costs [29]	n/a
SUBO	Outpatient and inpatient services at health centre level, inpatient only at national hospital, national centres and referral hospital level [30], user fees [40]	n/a
China:
URBMI	Inpatient care and critical outpatient care for accidents or limited chronic/fatal diseases (coronary heart disease, renal haemodialysis) [14] No preventive care More services covered in richer coastal cities [42]	Local governments determine financing level and details of arrangements. Less than UEBMI: no Medical Savings Account, most outpatient services are not covered except for very few selected diseases [14]
NRCMS	Inpatient and outpatient services in about 70 % of NRCMS counties, only inpatient services in the other 30 % Listed drugs (approx. 400) [78] There are 4 models of how NRCMS operates throughout China: Model I (in place in 17 % of counties): Inpatient services only Model II (in place in 11 % of counties): Inpatient services and outpatient services for catastrophic diseases (separate deductibles and reimbursement caps) Model III (in place in 7 % of counties): Inpatient services according to a formula, outpatient services and preventive care according to specific formula through collective funds (usually no deductible and reimbursement cap) Model IV (in place in 65 % of counties): Inpatient services according to a formula, outpatient services and preventive care paid through household medical savings account (with deductible and reimbursement cap) [90]	Less than UEMBI [78]
India:
RSBY	Mainly inpatient secondary care: inpatient services on a “day care” basis (subject to sub-limits), transport allowance; pre-existing conditions (minimal exclusions) and maternity covered, care delivered in network hospitals including private hospitals (free choice); recently outpatient consultations [74] Public transport costs up to Rs. 100 per visit and Rs. 1000 per year, post hospitalisation drugs for 5 days [91]	Less: ceiling, no out-patient services, no medicines as in CGHS, no preventive and wellness care and no compensatory cash benefits for loss of wages in case of illness or maternity (ESIS) [24]
Yeshasvini	Inpatient secondary and tertiary care: all inpatient charges associated with 823 specified surgical procedures (except transportation) excluded are certain high tech procedures No follow-up investigation; no diagnostic-test for non-surgery-related issues, no medicines Included outpatient consulting at a network of hospitals, since 2007 out-door treatment for stabilization of specific medical emergencies, normal deliveries and paediatric care during first 5-days of live, angioplasty procedure [92]	Less: ceiling, no medicines, no preventive and wellness care (all compared to CGHS) and no compensatory cash benefits for loss of wages in case of illness or maternity (ESIS) [24]
Rajiv Aarogyasri	938 hospitalization procedures (surgical and medical), largely tertiary care and some secondary care [24]	Less: ceiling, no out-patient services, no medicines as in CGHS, no maternity, no preventive and wellness care and no compensatory cash benefits for loss of wages in case of illness or maternity (ESIS) [24]
Kalaignar	Inpatient tertiary care (626 surgical procedures) [12]	n/a
Vajapayee Arogyasri	Inpatient tertiary care including 402 predefined packages and 50 follow-up packages [12]	n/a
Indonesia	Free outpatient primary care in local health centres and third class public hospital inpatient services (registration required) including preventive measures and maternity at public and private (only few) providers [93] No annual physical check-ups, dental prostheses, fertility treatment, indirect costs (e.g. transportation) [60]	Less: Askes and Jamsostek include additional annual physical check-up, under Jamsostek more private providers but larger exclusions of conditions [60] As of 2012, Jamsostek also covers catastrophic cases. [33]
Mongolia	Outpatient services at secondary and tertiary care levels; since 2010 outpatient diagnostic test up to 30 000 MNT per case per month; curative and palliative inpatient care, rehabilitation and long-term care; part of outpatient prescription drug expenses if on National Essential Drug list [88]	n/a
Philippines	Outpatient care, inpatient cute care, emergency care, day surgeries, inpatient care in accredited hospitals [35]	More: outpatient care [35]
Thailand	(Curative and preventive) outpatient and inpatient health services, rehabilitation, certain high-tech medical services (radio- and chemotherapy) but not all, prescription drugs on a national list Beneficiaries must follow the referral system (gatekeeper) to obtain free care Services usually at District Health System (district health centres and hospitals), except for emergencies/accidents [94]	Less than CSMBS More than SSS [36]
Vietnam	All ambulatory and hospital basic, advanced diagnostic curative health services and therapeutic services (including high-tech medical services), referral for higher level services required, drugs inside reimbursement list, transportation costs in case of referral No occupational diseases, medical aid devices, rehabilitation or home care [15]	Same [15]

Legend: UEBMI Urban Employee Basic Medical Insurance (China), Askes Asuransi Kesehatan (Indonesia), Jamsostek Jaminan Sosial Tenaga Kerja (Indonesia), CSMBS Civil Servant Medical Benefit Scheme (Thailand), SSS Social Security Scheme (Thailand), CGHS Central Government Health Scheme (India), ESIS Employees’ State Insurance Scheme (India)