Post Disbursement Coverage Appraisal

Abstract

To align health benefit package design with post-disbursement, this framework pools payer, provider, and consumer records at the episode-of-care level, generating structured evidence for benefit package revision cycles. It unifies four elements into one architecture: episode of care as unit; payer, provider, and consumer as sources; population, service, and cost as pooled dimensions; and a combined record as output. Records are linked through three methods: direct linkage using shared identifiers between payer and provider; composite matching on visit date, facility, and service category where no identifier exists; and administrative-boundary matching where identifiers are unavailable. Each method draws on independent precedent; this framework proposes combining them into one three-party post-disbursement coverage record. The record establishes three fixed correspondences: population coverage to entitlement administration, service coverage to provider arrangements, and cost coverage to reimbursement. The same unit, sources, and dimensions read whatever content a tax-funded, social insurance, national insurance, or out-of-pocket-dominant system generates in its institutional form, requiring no new data collection beyond what the revision cycle already convenes. Linkage completeness is reported alongside the record, as both a baseline of current capacity and a target for future strengthening. The record enters the policy dialogue step as an add-on layer of data and evidence for the benefit package revision cycle that countries convene. Keywords: Universal health coverage; Health systems strengthening; Health governance; Health policy and practice; Health Benefits Package.