Minimum coverage lists on the private sector: international benchmarks review

Abstract

Objective: Analysis of regulatory practices and functioning of health systems in different countries, with a primary focus on the regulation of health plans linked to the private sector. Method: A literature review was conducted and complemented with information collected by a desk search. The search was carried out on MEDLINE, considering publications dated in 2018 and 2019. The 23 countries evaluated were organized into five groups. Results: The data pointed to similarities between the grouped countries, regarding their health systems’ main characteristics and the participation of the supplementary health sector. Globally prevailing health systems with universal coverage and financed by social security contributions and general taxes. In some countries, the participation of the private sector is complementary, and offers services not covered by the public sector. In others, it is supplementary, offering similar services to the public sector with a wider range of providers. Co-payment strategies and the use of minimum coverage lists are prevalent. However, the mechanisms and frequencies of their updates are variable. Conclusion: Most of the countries analyzed adopt public and universal systems, which are supplemented, in a variable way, by the liberal practice of the health professions and by services from the private business sector. Minimum coverage and co-payment lists are adopted by several countries, from different regions. The frequency of updating the lists is variable, with annual updates being more common, using different strategies for the evaluation of health technologies.