Determinants of Essential Health Care Package Decisions

Abstract

The package of essential health care services performed by the public health care has been influenced by many specific determinants. They are a result of the procedural fairness, distributive justice, efficiency improvement, risk avoidance, social solidarity, regulated competition and medical progress. In such a situation, any essential package definition induces an out of pocket option, which has important consequences for the package ranking of services. In particular, for services with the same effect/cost ratios that are all close to the threshold level, the essential package should include services with large costs but not those with small costs. Those last services should be purchased out of pocket. That being so the decision making procedure concerning the essential package must consist at least of the following phases: choice of conditions, selection of services, tradeoffs, and individual payment.