Institutional design aspect | Related policy choices | Intermediate output indicators | UHC progress indicators |
---|---|---|---|
Eligibility and enrolment rules | |||
 Groups eligible for exemption from contributions/subsidization | Definition of vulnerability (e.g. children, unemployed, pregnant women, informal sector workers, poor, near poor) | Share of the eligible among the bottom two income quintiles and other vulnerable groups |  |
 Targeting method | E.g. universal (based on a very broad criterion such as residence or no employment in the formal sector), indirect (based on socio-demographic, socio-economic or geographic characteristics usually correlated with poverty and vulnerability), direct (through a means assessment or proxy means testing); different targeting approaches can be in place at the same time for different groups | Share of the exempted/subsidized within total (insured) population; Share of the exempted/subsidized among those being targeted for exemption/subsidization (targeting effectiveness of the system) | |
 Enrolment process | Active enrolment by the beneficiary or automatic enrolment by the authorities | Total population coverage (i.e. enrolment in health insurance fund), differentiated along income quintiles | |
 Organization responsible for identification of the exempted non-contributors/the subsidized | E.g., insurance company; central, regional, local government | ||
 Type of affiliation/membership | Mandatory or voluntary | ||
Financing arrangements | |||
 Degree of subsidization/co-contribution | Full or partial (a co-contribution is required) | Share of the exempted/subsidized within total (insured) population/those being targeted for subsidization (importance of government revenue) | |
 Type of transfer mechanism | Individual-based (a specific amount is being paid for each exempted individual), or lump-sum (a lump sum transfer for the entire exempted population is made) |  |  |
 Calculation logic to determine the amount of funds to be transferred | E.g., based on regular contribution levels, minimum or average wages, specific percentage of the government budget, negotiated by the government | Sufficient funding for a comprehensive benefit package Level of cross-subsidization from contributions | Financial protection (incidence of catastrophic* / impoverishing health expenditure), also differentiated along income quintiles and other aspects; Access to services |
 Source of funding for state budget transfers | E.g. general government revenues, earmarked government revenues, transfers from other health insurance funds or from contributors within the same pool (cross-subsidization), donor funding | ||
Pooling arrangements | |||
 Type of pool(s) (general) | Single pool, or multiple pools | Degree of fragmentation, Size and composition of pools, Level of cross-subsidization | Equity in access (everybody has same access to services along their needs, indepen-dent of their contributions; Equity in financing (every household contributes accor-ding to their ability to pay); Financial protection |
 Type of pool (exempted/subsidized) | Exempted/subsidized integrated in the pool with contributors, or separate pool for the exempted/subsidized | ||
 Type of health insurance membership of contributors | Voluntary or mandatory | ||
Purchasing arrangements and benefit package design | |||
 Range of services covered by the benefit package | E.g. comprehensive, inpatient focus, outpatient focus, pharmaceuticals, dental care, indirect costs (e.g. transportation) Different or same package as that for contributors |  | Financial protection; Access (utilization rates); Equity in access |
 Type of providers offering the benefit package | Public, private providers | ||
 Degree of cost-sharing | Cost-sharing mechanisms (e.g., co-insurance, co-payment, deductible) and rates | ||
 Provider payment mechanisms | Type of provider payment and rates Same or different rules and rates of provider payment methods | Efficiency |  |