As countries worldwide explore health system reforms to progress toward UHC, policymakers face challenging, morally complex decisions about what and whom to cover with their limited health budgets. Because priority-setting is inherently driven by values, and decisions about whether to cover a health intervention have ethically important consequences for those in need of services, an ethics framework for priority-setting can be a critical tool to inform better decision making for health on the path to UHC. Attention to clearly defined ethics commitments can improve the design and delivery of a health benefits package across the entire policy cycle, including: setting strategic goals for UHC reforms, selecting the set of health services to cover, and measuring impacts on ethically important indicators — such as equity.

Chapter 13 in What’s In, What’s Out: Designing Benefits for Universal Health Coverage–A Matter of Morality: Embedding Ethics and Equity in the Health Benefits Policyoffers a how-to guide for countries to develop ethics frameworks for priority-setting tailored to their specific contexts and policy objectives. The Chapter covers a range of ethics commitments that countries may want to adopt as they pursue UHC goals. These may include:

• addressing various types of inequities
• optimizing value-for-money through efficient health spending
• enhancing evidence-based decision-making, and
• assessing to how coverage decisions may affect other important aspects of wellbeing not directly related to health — such as social relationships, respect, and financial protection.

The Chapter also covers the need for evidence to inform ethics analyses, and how monitoring, evaluation, and learning activities for UHC policies and programs can be designed to enhance the evidence base and track progress on important ethics dimensions.