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evaluation findings to inform the evidence base.

Through these case studies, we found little evidence that any one reform performed consistently well. Even PBF in Rwanda, which had strong country-specific evidence of improving quality of care, failed to improve other markers of UHC such as equitable access to care. Furthermore, it’s mostly unknown if eliminating user fees or implementing CBHI violates any of Norheim’s unacceptable tradeoffs. In the Philippines, for example, if eliminating user fees for vulnerable populations threatens the financial viability of hospitals, that reform could make the health system less equitable by driving patients into private sector clinics that are more likely to charge high user fees.

Using these case studies, we highlight that policy evaluation requires a differential approach based on the data availability, outcomes of interest, and the means of policy implementation. In our paper, we proposed using difference-in-differences and time series evaluation approaches for our three case study questions, although we do not mean to imply that these are the only models available to researchers. For example, cluster randomized trials can produce a high standard of evidence, but their high resource costs and need for researcher control over intervention implementation prevented us from recommending it for any of our case studies.