Breve 26. Designing and Costing a Health Benefits Package in a Lower Middle-Income Country the Case of Honduras
Honduras is a lower-middle income country with a fragmented health system and less than US$100 per capita per year to meet its health needs. Within the framework of its commitment to Universal Health Coverage (CUS), the government decided to design a Health Benefits Plan (PBS). The design of the PBS was carried out in five steps. (1) An inter-institutional team from the Honduran Ministry of Health and the Social Security Institute defined the fundamental characteristics of the PBS. (2) Taking advantage of previous work carried out in the country, the universe of potential candidates for inclusion was identified. (3) Prioritization criteria and decision rules were discussed and operationalized. (4) A bottom-up approach was used to cost the PBS, with the current low coverage and with different objectives of improving coverage levels. (5) Fiscal impact analyzes were prepared and alternative paths of expansion were discussed with the government, proposing ethical criteria on the path towards UHC. The resulting PBS includes 74 essential health interventions. Given financial constraints, a progressive expansion path was suggested, whereby marginal increases in the health budget would be allocated to PBS. The design of a PBS is a specific process for each context; it includes several steps that go beyond the implementation of health technology assessment methods and requires a lot of technical and participatory work time and substantial pragmatism to adapt the technical recommendations of the literature to the data and time constraints in the field.