The Joint Learning Network for Universal Health Coverage systematically documents the reforms of its member countries and other countries that have expanded health coverage through demand-side financing. The case studies contained in these pages are brief, comparative and modular in nature, describing the key highlights and technical features of each program.
Compare various dimensions of country reform efforts using our interactive tool.
| Program | Types of benefits | Benefits package |
|---|---|---|
| Colombia: General System of Social Security in Health |
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One controversial component of the Colombian health system is that CR members—the wealthier—receive a richer benefits package than the poorer SR members. The CR benefits package covers all levels of care including inpatient, outpatient, maternity leave, and sick leave. The SR package covers all low-complexity care and catastrophic illnesses but provides only limited coverage for most hospital care and no short term disability coverage. Read full sectionOne controversial component of the Colombian health system is that CR members—the wealthier—receive a richer benefits package than the poorer SR members. The CR benefits package covers all levels of care including inpatient, outpatient, maternity leave, and sick leave. The SR package covers all low-complexity care and catastrophic illnesses but provides only limited coverage for most hospital care and no short term disability coverage. The SR is complemented by services provided by public hospitals, financed through direct payments to providers from the state, independent of what services they supply and of patients’ insurance status. General System of Social Security in HealthBenefits package Types of Benefits: Comprehensive One controversial component of the Colombian health system is that CR members—the wealthier—receive a richer benefits package than the poorer SR members. The CR benefits package covers all levels of care including inpatient, outpatient, maternity leave, and sick leave. The SR package covers all low-complexity care and catastrophic illnesses but provides only limited coverage for most hospital care and no short term disability coverage. The SR is complemented by services provided by public hospitals, financed through direct payments to providers from the state, independent of what services they supply and of patients’ insurance status. |
| Rwanda: Mutuelles de Sante |
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The benefits package in Rwanda has two primary parts: the Minimum Package of Activities (MPA) and the Complementary Package of Activities (CPA). The MPA covers all services and drugs provided at the health centers including pre- and post-natal care, vaccinations, family planning, minor surgical operations, and essential and generic drugs. All individuals in Rwanda with health insurance are entitled to comprehensive, subsidized preventative care through the MPA. The CPA covers a limited number of services at the district hospitals, including the cost of hospitalization, caesarian operations, minor and major surgical operations, medical imaging, and all diseases afflicting children ages 0 to 5 years. Read full sectionThe benefits package in Rwanda has two primary parts: the Minimum Package of Activities (MPA) and the Complementary Package of Activities (CPA). The MPA covers all services and drugs provided at the health centers including pre- and post-natal care, vaccinations, family planning, minor surgical operations, and essential and generic drugs. All individuals in Rwanda with health insurance are entitled to comprehensive, subsidized preventative care through the MPA. The CPA covers a limited number of services at the district hospitals, including the cost of hospitalization, caesarian operations, minor and major surgical operations, medical imaging, and all diseases afflicting children ages 0 to 5 years. As of 2006, the CPA benefits package was extended to cover select services in national hospitals. In order to receive these benefits, individuals must be referred from the health centers to district or national level hospitals. Mutuelle members are entitled to comprehensive benefits for primary care, secondary care, and tertiary care provided through public or private non-profit contracted facilities. The scheme provides basic services such as family planning, pre-natal care, consultations, basic laboratory examinations, generic drugs, and hospital treatment. All medications from hospitals are also included in the benefits. For those covered under RAMA, benefits include all the major preventative services in addition to all curative services and pharmaceuticals. The benefits package for MMI is the same as RAMA, with the addition of prostheses coverage added under MMI. Excluded are contact lenses and braces as well as cosmetic surgery for purely aesthetic reasons. RAMA and MMI have signed contracts with all public health centers and reference hospitals, as well as 16 private institutions. MMI has the added advantage of using military hospitals, thus, individuals covered under these plans are able to access health care benefits at almost all health centers in Rwanda. Mutuelles de SanteBenefits package Types of Benefits: Comprehensive The benefits package in Rwanda has two primary parts: the Minimum Package of Activities (MPA) and the Complementary Package of Activities (CPA). The MPA covers all services and drugs provided at the health centers including pre- and post-natal care, vaccinations, family planning, minor surgical operations, and essential and generic drugs. All individuals in Rwanda with health insurance are entitled to comprehensive, subsidized preventative care through the MPA. The CPA covers a limited number of services at the district hospitals, including the cost of hospitalization, caesarian operations, minor and major surgical operations, medical imaging, and all diseases afflicting children ages 0 to 5 years. As of 2006, the CPA benefits package was extended to cover select services in national hospitals. In order to receive these benefits, individuals must be referred from the health centers to district or national level hospitals. Mutuelle members are entitled to comprehensive benefits for primary care, secondary care, and tertiary care provided through public or private non-profit contracted facilities. The scheme provides basic services such as family planning, pre-natal care, consultations, basic laboratory examinations, generic drugs, and hospital treatment. All medications from hospitals are also included in the benefits. For those covered under RAMA, benefits include all the major preventative services in addition to all curative services and pharmaceuticals. The benefits package for MMI is the same as RAMA, with the addition of prostheses coverage added under MMI. Excluded are contact lenses and braces as well as cosmetic surgery for purely aesthetic reasons. RAMA and MMI have signed contracts with all public health centers and reference hospitals, as well as 16 private institutions. MMI has the added advantage of using military hospitals, thus, individuals covered under these plans are able to access health care benefits at almost all health centers in Rwanda. |
| Brazil: Unified Health System (SUS) |
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Brazil’s health system offers free, universal coverage. Care under the SUS is divided into basic, specialized, and high complexity categories. Basic care is composed of health promotion and disease prevention. Care is deemed specialized if the intervention requires the use of a medical specialist. Finally, complex care is composed of interventions that require the use of advanced technology and equipment. Read full sectionBrazil’s health system offers free, universal coverage. Care under the SUS is divided into basic, specialized, and high complexity categories. Basic care is composed of health promotion and disease prevention. Care is deemed specialized if the intervention requires the use of a medical specialist. Finally, complex care is composed of interventions that require the use of advanced technology and equipment. The PSF’s original priority areas were: women’s health, child health, hypertension, diabetes, tuberculosis, leprosy, HIV, oral health, and health promotion. Unified Health System (SUS)Benefits package Types of Benefits: Comprehensive Brazil’s health system offers free, universal coverage. Care under the SUS is divided into basic, specialized, and high complexity categories. Basic care is composed of health promotion and disease prevention. Care is deemed specialized if the intervention requires the use of a medical specialist. Finally, complex care is composed of interventions that require the use of advanced technology and equipment. The PSF’s original priority areas were: women’s health, child health, hypertension, diabetes, tuberculosis, leprosy, HIV, oral health, and health promotion. |
| Thailand: Universal Coverage Scheme |
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UCS beneficiaries are entitled to a comprehensive benefits package, including both inpatient and outpatient care. In addition to curative services (with some exclusions), UCS provides for preventive care for all Thai citizens, focused on health promotion and disease prevention (e.g., immunizations, annual physical checkups, premarital counseling, antenatal care and family planning services, etc.). Recently, coverage has also been extended to ARV treatment for HIV/AIDs and renal replacement therapy. Read full sectionUCS beneficiaries are entitled to a comprehensive benefits package, including both inpatient and outpatient care. In addition to curative services (with some exclusions), UCS provides for preventive care for all Thai citizens, focused on health promotion and disease prevention (e.g., immunizations, annual physical checkups, premarital counseling, antenatal care and family planning services, etc.). Recently, coverage has also been extended to ARV treatment for HIV/AIDs and renal replacement therapy. The curative package covers ambulatory and hospitalization services with some exclusions, such as cosmetic surgery, infertility treatments, organ transplants, and the provision of private room and board. For high-cost care, the UCS has adopted a similar package to the one provided by the SSS in order to standardize the packages across the scheme to minimize inequities in health care services. Thus, substantial high-cost interventions are offered. All contracted public and private providers are bound to provide registered beneficiaries with these and other preventative services. ART treatment and renal replacement therapy coverage was extended beginning in October 2003 and January 2008 respectively, because of strong social movements pushing for these inclusions. In January 2008, based on a cost-benefit analysis, the NHS Board decided to provide the seasonal flu vaccination to high-risk groups. There was no increase to the budget because it was determined that it costs less to vaccinate for the flu than to treat it. Evidence from a cost-benefit analysis showing that the cost of treatment and care for flu patients in high-risk groups is higher than the cost of vaccination has resulted in the decision to provide seasonal flu vaccination to high-risk groups. The decision to expand benefits to include renal replacement therapy from January 2008 is forecasted to increase the burden on the health care system. The table below illustrates some high cost inclusions and exclusions in the UCS. Included services
Excluded services
Universal Coverage SchemeBenefits package Types of Benefits: Comprehensive UCS beneficiaries are entitled to a comprehensive benefits package, including both inpatient and outpatient care. In addition to curative services (with some exclusions), UCS provides for preventive care for all Thai citizens, focused on health promotion and disease prevention (e.g., immunizations, annual physical checkups, premarital counseling, antenatal care and family planning services, etc.). Recently, coverage has also been extended to ARV treatment for HIV/AIDs and renal replacement therapy. The curative package covers ambulatory and hospitalization services with some exclusions, such as cosmetic surgery, infertility treatments, organ transplants, and the provision of private room and board. For high-cost care, the UCS has adopted a similar package to the one provided by the SSS in order to standardize the packages across the scheme to minimize inequities in health care services. Thus, substantial high-cost interventions are offered. All contracted public and private providers are bound to provide registered beneficiaries with these and other preventative services. ART treatment and renal replacement therapy coverage was extended beginning in October 2003 and January 2008 respectively, because of strong social movements pushing for these inclusions. In January 2008, based on a cost-benefit analysis, the NHS Board decided to provide the seasonal flu vaccination to high-risk groups. There was no increase to the budget because it was determined that it costs less to vaccinate for the flu than to treat it. Evidence from a cost-benefit analysis showing that the cost of treatment and care for flu patients in high-risk groups is higher than the cost of vaccination has resulted in the decision to provide seasonal flu vaccination to high-risk groups. The decision to expand benefits to include renal replacement therapy from January 2008 is forecasted to increase the burden on the health care system. The table below illustrates some high cost inclusions and exclusions in the UCS. Included services
Excluded services
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