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Developing a national coverage plan

Updated by Xenia Scheil-Adlung on 12.06.2015

The national coverage plan aims to provide a coherent design of coordinated pluralistic national health financing coverage and delivery systems consisting of sub-systems, such as national tax-based services and social health insurances schemes, private insurance schemes, etc.  Aiming at universal coverage, these would operate within a clearly defined scope of competence and cover defined subsections of the population.

The objectives of the coverage plan thus consist of:

  • determining subsystems covering all population subgroups;
  • developing adequate benefit packages and related financial protection in each subsystem;
  • determining the rules governing the financing mechanisms for each subsystem and the financial linkages between them (also as financial risk equalization between different subsystems, if any);
  • maximizing institutional and administrative efficiency in each subsystem and the system as a whole,
  • determining the time frame in which universal coverage would be reached.

At all levels, decisions on key aspects should be based on broad social dialogue that includes social partners and representatives of patients, healthcare workers, healthcare providers and the government.

The objectives can be met by proceeding through a series of strategic activities:

  1. Developing a national health budget
  2. Improving health financing mechanisms
  3. Building rational linkages between subsystems
  4. Designing adequate benefit packages
  5. Creating institutional and administrative efficiency