In 1999, teams from Mexico, Colombia, Pakistan, and Thailand adapted a matrix for evaluating the fairness of U.S. national insurance reform proposals into a tool appropriate for developing countries. It has nine benchmarks, each containing criteria for assessing the degree to which reform proposals improve the situation relative to the status quo on these dimensions: intersectoral risk factors and their distribution, access to health sector services, the comprehensiveness and "tiering" of benefits, equity in financing, administrative and clinical efficiency and quality, accountability, and choice. The tool achieves objectivity by requiring that rationales be given for scores assigned. In a second phase of research, new sites will be added in Asia, Latin America, and Africa. The tool gives prominence to primary health care, requiring evaluation of the effects of reform on primacy care; there is no conflict between it and the historical emphasis given to primary care in the previous century. The benchmarks can be improved by incorporating more specific measures of equity in health and health care, such as those developed in the Rockefeller Equity Gauge project and in the components of the WHO Framework for measuring health system performance. What is distinctive about the benchmarks is their orientation toward action. They are designed to evaluate and improve proposals to reform system performance as measured by other approaches. How the benchmarks complement other approaches will be illustrated in more detail.
Learning Objectives: To appreciate the place of fairness in assessing or formulating health policy reforms. To consider ways in which benchmarks of fairness can facilitate deliberations regarding reform options. To appreciate ways in which the benchmarks are complementary to both primary health care and the WHO framework for assessing health system performance
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.