Health Benefit Package Revision Is an Art as Much as a Science – Lessons Learned on the Organization of the Appraisal Phase

Articles in Press

Document Type : Editorial

Authors

1 Radboud University Medical Center, Nijmegen, The Netherlands

2 Ministry of Health and Medical Education, Tehran, Iran

3 World Health Organisation (WHO), Geneva, Switzerland

4 Aga Khan University, Karachi, Pakistan

5 London School of Hygiene & Tropical Medicine, London, UK

6 University of Rwanda, Kigali, Rwanda

7 Ministry of Health, Astana, Kyrgyzstan

Abstract

Many low- and middle-income countries are designing or revising their health benefit packages (HBPs), with appraisal—prioritizing services for reimbursement—being a critical phase. This occurs in a complex landscape of multiple criteria, multiple stakeholders, limited evidence, budget constraints, and tight timelines, varying across countries. Existing guidance documents do not fully address these complexities, requiring analysts to balance methodological rigor with practical constraints. This editorial highlights four key themes in organizing appraisal: decision-making structures, trade-offs between criteria, final recommendations, and the use of cost-effectiveness evidence, thresholds, and budgets. These emerged as central challenges in HBP revisions in Iran, Kyrgyzstan, Liberia, Pakistan, and Rwanda. We emphasize cross-country learning to address these challenges pragmatically, recognizing that high-quality, legitimate appraisal is as much an art as a science. More detailed documentation of appraisal processes is needed to refine HBP revision guidelines and strengthen priority-setting in health systems. 

Keywords

References

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International Journal of Health Policy and Management

Articles in Press, Corrected Proof
Available Online from 16 February 2025

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History

  • Receive Date: 23 September 2024
  • Revise Date: 05 February 2025
  • Accept Date: 11 February 2025
  • First Publish Date: 16 February 2025

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