POSSIBLE OBJECTIVES AND RESULTING ENTITLEMENTS OF ESSENTIAL HEALTH-CARE PACKAGES

The notion of a defined 'core package of essential health care service s' has appeared in many different health reform proposals in the 1990s . This paper attempts to explore the possible objectives of the 'core package' component of health care reform. Two broad applications are a pparent: the use of essential packages to ration scarce public funds a nd the incorporation of a minimum benefit package,into 'managed compet ition' type reforms, where they constitute a mandated minimum lever of private insurance cover. Eight possible objectives for an essential b enefit package are described: To protect against catastrophic illness events; to ensure social risk pooling; to improve allocative efficienc y in the health system; to eliminate 'high burden of disease' conditio ns; to improve equity of access to services; to combat cost-escalation ; to encourage competition between insurers; and to facilitate public participation and transparency in decision making. Closer examination of objectives reveals that they often conflict, which suggests that a clear understanding of the purpose of reform is essential before it is worthwhile devoting energy to the development of essential benefit pa ckages. It is argued that two main clusters of objectives emerge from the eight described, representing Rawlsian (risk avoidance) and utilit arian (efficiency improvement) social welfare philosophies, respective ly. Practical experience suggests that priority setting exercises have been unsuccessful in meeting efficiency objectives, but that they may well be quite useful in fulfilling risk-pooling aims. (C) 1998 Elsevi er Science Ireland Ltd. All rights reserved.