Title What’s In, What’s Out
Subtitle Designing Benefits for Universal Health Coverage
Author Amanda Glassman, Ursula Giedion, Peter C. Smith
ISBN 9781933286891
List price USD 19.95
Price outside India Available on Request
Original price
Binding Paperback
No of pages 300
Book size 204 X 254 mm
Publishing year 2017
Original publisher Brookings University Press
Published in India by Brookings Institution Press
Exclusive distributors Viva Books Private Limited
Sales territory India, Sri Lanka, Bangladesh, Pakistan, Nepal, .
Status New Arrival
About the book Send Enquiry


Vaccinate children against deadly pneumococcal disease, or pay for cardiac patients to undergo lifesaving surgery? Cover the costs of dialysis for kidney patients, or channel the money toward preventing the conditions that lead to renal failure in the first place? Policymakers dealing with the realities of limited health care budgets face tough decisions like these regularly. And for many individuals, their personal health care choices are equally stark: paying for medical treatment could push them into poverty.

Many low- and middle-income countries now aspire to universal health coverage, where governments ensure that all people have access to the quality health services they need without risk of impoverishment. But for universal health coverage to become reality, the health services offered must be consistent with the funds available—and this implies tough everyday choices for policymakers that could be the difference between life and death for those affected by any given condition or disease. The situation is particularly acute in low- and middle income countries where public spending on health is on the rise but still extremely low, and where demand for expanded services is growing rapidly.

What’s In, What’s Out: Designing Benefits for Universal Health Coverage argues that the creation of an explicit health benefits plan—a defined list of services that are and are not available—is an essential element in creating a sustainable system of universal health coverage. With contributions from leading health economists and policy experts, the book considers the many dimensions of governance, institutions, methods, political economy, and ethics that are needed to decide what’s in and what’s out in a way that is fair, evidence-based, and sustainable over time.


Foreword (Lord Darzi of Denham and Kalipso Chalkidou)



About This Book

INTRODUCTION: The Health Benefits Package: Bringing Universal Health Coverage from Rhetoric to Reality (Amanda Glassman Ursula Giedion and Peter C. Smith)

Policymaker Commentary

Revisiting and Reformulating: How Explicit Benefit Packages Have Helped Mexico Move toward Universal Health Coverage (Eduardo Gonzalez-Pier)

PART I: GOVERNANCE AND PROCESS: The Foundation of a Health Benefits Package Policy

Introduction (Ursula Giedion)

Chapter 1: Defining the Rules of the Game: Good Governance Principles for the Design and Revision of the Health Benefits Package (Ursula Giedion and Javier Guzman)

Chapter 2: Tracking the Benefits Package from Paper to Practice: Monitoring and Evaluation
(Ricardo Bitran)

Chapter 3: Managing the Money: Fiscal and Budgetary Considerations for the Benefits Package
(Amanda Glassman)

Policymaker Commentary

Aspiring to National Health Insurance, South Africa Considers Its Benefits Package (Mark Blecher and Yogan Pillay)

PART II: PUTTING PEN TO PAPER: Methods to Select a Benefits Plan That Works

Introduction (Peter Smith)

Chapter 4: How Much Health for the Money? Using Cost-Effectiveness Analysis to Support Benefits Plan Decisions (Mark Sculpher, Paul Revill, Jessica M. Ochalek, and Karl Claxton)

Chapter 5: Benefits beyond Health: Evaluating Financial Risk Protection and Equity through Extended Cost-Effectiveness Analysis (Stephan Verguet and Dean T. Jamison)

Chapter 6: Comparing Apples and Oranges: Strategies to Weigh Health against Other Social Values (Alec Morton and Jeremy A. Lauer)

Chapter 7: Square Pegs, Round Holes: Addressing Health Sector Interventions with Non-Health Benefits (Rachel Silverman)

Chapter 8: At What Price? Costing the Health Benefits Package (Cheryl Cashin and Annette Ozaltin)

Chapter 9: Beyond Cost Effectiveness: Health Systems Constraints to Delivery of a Health Benefits Package (Katharina Hauck, Ranjeeta Thomas, and Peter C. Smith)

Chapter 10: See the Bigger Picture: Resource Optimization Tools to Inform HBP Design (Marelize Gorgens, Janka Petravic, David J. Wilson, and
David P. Wilson

Chapter 11: Reliable Sources? Generating, Selecting, and Applying Evidence to Inform the Health Benefits Package (Neil Hawkins, Robert Heggie, and Olivia Wu)

Policymaker Commentary

Confronting Tight Fiscal, Human Resource, and Evidence Constraints, Malawi Revises Its Benefits Package (Gerald Manthalu, Dominic Nkhoma, Jessica M. Ochalek, Andrew Phillips, and Paul Revill)

Policymaker Commentary

More than a List: Reforming a Country’s Health Benefits Package —A Rigorous Approach to Tackling Costly Overutilization (Yot Teerawattananon, Waranya Rattanavipapong, Benjarin Santatiwongchai, Thanaporn Bussabawalai, Kittiphong Thiboonboon, and Saudamini Dabak)

Policymaker Commentary

Starting with the Essential Medicines List: How New Zealand’s PHARMAC Prioritizes and Purchases Pharmaceutical Benefits
(Thomas Wilkinson)

PART Ill: TOUGH CHOICES Considering Ethics, Rights, and Political Economy in Defining Benefits

Introduction (Amanda Glassman)

Chapter 12: Priority-Setting as Politics: A Political Economy Framework for Analyzing Health Benefits Package Decisions (Jesse B. Bump and
Angela Y. Chang

Chapter 13: A Matter of Morality: Embedding Ethics and Equity in the Health Benefits Policy (Carleigh Krubiner and Ruth Faden)

Chapter 14: The Right to Health and the Health Benefits Package: Accounting for a Legal Right to Health When Designing a HBP (Rebecca Dittrich, Leonardo Cubillos, Lawrence Gostin, Kalipso Chalkidou, and Ryan Li)

Policymaker Commentary

Chile’s Guaranteed Package of Health Benefits Navigates Political Challenges (Antonio Infante)

Additional Resources




About the Editors:

Amanda Glassman is the chief operating officer and a senior fellow at the Center for Global Development. Her research focuses on priority-setting, resource allocation and value for money in global health, and data for development. Previously, she served as director for global health policy at the Center from 2010 to 2016 and as principal technical lead for health at the Inter-American Development Bank from 2007 to 2010, where she led policy dialogue, designed the results-based grant program Salud Mesoamerica, and was team leader for conditional cash transfer programs. She has more than 25 years of experience working on health and social protection in Latin America and elsewhere in the developing world.

Ursula Giedion is a health specialist with over 25 years of international experience in health systems policy. Since 2010 she has served as a senior consultant for the Inter-American Development Bank, where she provides technical assistance to Latin American countries in the area of health care financing and explicit priority setting, and leads CRITERIA—a regional network on explicit priority setting and benefits package design. She works with international organizations on issues related to universal coverage, health care reforms, health care financing, benefits package design, and policies to improve the efficiency of health care spending. She has published on a wide range of issues with a focus on health benefits packages and explicit priority setting.

Peter C. Smith is Emeritus Professor of Health Policy at Imperial College Business School. He is a health economist who previously served as Director of the Centre for Health Economics at the University of York and has published widely on the finance and efficiency of health systems. He has advised numerous governments, including the UK, and several international agencies, including the World Health Organization, the International Monetary Fund, the World Bank, the European Commission, and the Organisation for Economic Co-operation and Development. He continues to research economic aspects of health systems and global health.

Target Audience:

People interested in the economics of insurance benefits and health policies.


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