International Journal of Health Policy and Management

International Journal of Health Policy and Management

Health Benefit Package Revision Is an Art as Much as a Science – Lessons Learned on the Organization of the Appraisal Phase

Document Type : Editorial

Authors
Rob Baltussen 1
Mojtaba Nouhi 2
Andrew Mirelman 3
Sameen Siddiqi 4
Cassandra Nemzoff 5
Gavin Surgey 1
Stella Umuhoza 6
Saltanat Zhetibaeva 7
Baktygul Isaeva 7
Anna Vassal 5
1 Radboud University Medical Center, Nijmegen, The Netherlands
2 Ministry of Health and Medical Education, Tehran, Iran
3 World Health Organisation (WHO), Geneva, Switzerland
4 Aga Khan University, Karachi, Pakistan
5 London School of Hygiene & Tropical Medicine, London, UK
6 University of Rwanda, Kigali, Rwanda
7 Ministry of Health, Astana, Kyrgyzstan
10.34172/ijhpm.8819
Abstract
Many low- and middle-income countries are designing or revising their health benefit packages (HBPs), with appraisal—prioritizing services for reimbursement—being a critical phase. This occurs in a complex landscape of multiple criteria, multiple stakeholders, limited evidence, budget constraints, and tight timelines, varying across countries. Existing guidance documents do not fully address these complexities, requiring analysts to balance methodological rigor with practical constraints. This editorial highlights four key themes in organizing appraisal: decision-making structures, trade-offs between criteria, final recommendations, and the use of cost-effectiveness evidence, thresholds, and budgets. These emerged as central challenges in HBP revisions in Iran, Kyrgyzstan, Liberia, Pakistan, and Rwanda. We emphasize cross-country learning to address these challenges pragmatically, recognizing that high-quality, legitimate appraisal is as much an art as a science. More detailed documentation of appraisal processes is needed to refine HBP revision guidelines and strengthen priority-setting in health systems. 

Highlights

Rob Baltussen (Google Scholar) (PubMed)

Keywords
Health Benefit Package
Appraisal Phase
Guidance
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International Journal of Health Policy and Management
Volume 14, Issue 1
2025
Pages 1-6

  • Received Date 23 September 2024
  • Revised Date 05 February 2025
  • Accepted Date 11 February 2025
  • First Published Date 16 February 2025
  • Published Date 01 December 2025