New Public Governance in health care: Health Technology Assessment for Canadian pharmaceuticals

The Dutch healthcare system is not a single overall plan, but has evolved from a constantly changing mix of institutions, regulations, and responsibilities. The resulting system provides high-quality care with reasonable efficiency and equal distribution over the population. Every Dutch citizen is entitled to health care. Health insurance is provided by a mix of compulsory national insurance and public and private insurance schemes. Hospitals generally have a private legal basis but are heavily regulated. Supraregional planning of high-tech medical services is also regulated. Hospitals function under fixed, prospective budgets with regulation of capital investments. Independent general practitioners serve a gatekeeper role for specialist and hospital services and are paid by capitation or fee for service. Specialists are paid by fee for service. All physicians' fees are controlled by the Ministry of Economic Affairs. Coverage of benefits is an important method of controlling the cost of services. There is increasing concern about health care quality. Health technology assessment (HTA) has become increasingly visible during the last 15 years. A special national fund for HTA, set up in 1988, has led to many formal and informal changes. HTA has evolved from a research activity into policy research for improving health care on the national level. In 1993 the government stated formally that enhancing effectiveness in health care was one of its prime targets and that HTA would be a prime tool for this purpose. The most important current issue is coordination of HTA activities, which is now undertaken by a new platform representing the important actors in health care and HTA.

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HEALTH TECHNOLOGY ASSESSMENT AND CLINICAL DECISION MAKING:

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462399153121 ◽

1999 ◽

Vol 15 (3) ◽

pp. 585-592 ◽

Cited By ~ 18

Author(s):

Alicia Granados

Keyword(s):

Health Care ◽

Decision Making ◽

Health Technology Assessment ◽

Case Studies ◽

Technology Assessment ◽

Clinical Decision Making ◽

Clinical Decision ◽

Health Technology ◽

Evidence Based ◽

Systematic Process

This paper examines the rationality of the concepts underlying evidence—based medicineand health technology assessment (HTA), which are part of a new current aimed at promoting the use of the results of scientific studies for decision making in health care. It describes the different approaches and purposes of this worldwide movement, in relation to clinical decision making, through a summarized set of specific HTA case studies from Catalonia, Spain. The examples illustrate how the systematic process of HTA can help in several types of uncertainties related to clinical decision making.

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Health technology assessment in the United Kingdom

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462309090618 ◽

2009 ◽

Vol 25 (S1) ◽

pp. 178-181 ◽

Cited By ~ 10

Author(s):

Michael Drummond ◽

David Banta

Keyword(s):

Health Care ◽

United Kingdom ◽

Cost Effectiveness ◽

Health Technology Assessment ◽

Technology Assessment ◽

Clinical Excellence ◽

Present Situation ◽

Health Technology ◽

The United Kingdom ◽

Short Run

Objectives: The aim of this study was to describe generally the development and present situation with health technology assessment (HTA) in the United Kingdom.Methods: The methods used are a review of important materials that have described the development process and present situation, supplemented by some personal experiences.Results: The United Kingdom has been characterized historically as a country with a strong interest in evidence in health care, both clinical trials for efficacy and cost-effectiveness analyses. However, this evidence was not well-linked to the needs of the National Health Services (NHS) before formation of the NHS R&D Programme in 1991, The R&D Programme brought substantial resources into HTA and related activities, with the central aim of improving health care in Britain and increasing value for money. However, policy makers as well as staff of the R&D Programme were dissatisfied with the use of the HTA results in clinical and administrative practice. Therefore, the National Institute of Clinical Excellence (NICE) was formed in 1999. NICE issues guidance intended to influence practical decision making in health care at the national and local levels, based on efficacy information and, in some cases, economic analyses. NICE is now also seeking ways to maximize impacts on practice.Conclusions: The UK experience shows that information on clinical and cost-effectiveness may not be enough to change practice, at least in the short-run. Still, one may conclude that the United Kingdom now has one of the few most important and influential HTA programs in the world.

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History of health technology assessment in Belgium

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462309090461 ◽

2009 ◽

Vol 25 (S1) ◽

pp. 82-87 ◽

Cited By ~ 6

Author(s):

Irina Cleemput ◽

Philippe Van Wilder

Keyword(s):

Health Care ◽

Health Technology Assessment ◽

Technology Assessment ◽

Good Clinical Practice ◽

Health Technology ◽

Services Research ◽

Drug Reimbursement ◽

History Of ◽

The Impact ◽

Further Development

Objectives: This paper gives an overview of health technology assessment (HTA) in Belgium.Methods: The information included in the overview is based on legal documents and publicly available year reports of the Belgian Health Care Knowledge Centre (KCE).Results: Belgium has a relatively young history in HTA. The principle of evidence-based medicine (EBM) was introduced in the drug reimbursement procedure in 2001, with the establishment of the Drug Reimbursement Committee (DRC). The DRC assesses the efficacy, safety, convenience, applicability, and effectiveness of a drug relative to existing treatment alternatives. For some drugs, relative cost-effectiveness is also evaluated. The activities of the DRC can, therefore, be considered to be the first official HTA activities in Belgium. Later, in 2003, KCE was established. Its mission was to perform policy preparing research in the healthcare and health insurance sector and to give advice to policy makers about how they can obtain an efficient allocation of limited healthcare resources that optimizes the quality and accessibility of health care. This broad mission has been operationalized by activities in three domains of research: HTA, health services research, and good clinical practice. KCE is independent from the policy maker. Its HTAs contain policy recommendations that may inform policy decisions but are not binding.Conclusions: Although the Belgian history of HTA is relatively short, its foundations are strong and the impact of HTA increasing. Nevertheless KCE has many challenges for the future, including continued quality assurance, further development of international collaboration, and further development of methodological guidance for HTA.

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History of health technology assessment: Spain

International Journal of Technology Assessment in Health Care ◽

10.1017/s026646230909059x ◽

2009 ◽

Vol 25 (S1) ◽

pp. 163-173 ◽

Cited By ~ 14

Author(s):

Laura Sampietro-Colom ◽

Jose Asua ◽

Eduardo Briones ◽

Jordi Gol ◽

Keyword(s):

Health Care ◽

Health Technology Assessment ◽

Technology Assessment ◽

Policy Decision ◽

Health Technology ◽

Policy Coordination ◽

Public Healthcare ◽

Regional Government ◽

Health Care Environment ◽

Health Technologies

Objectives: The aim of this study was to describe the characteristics of the introduction and diffusion of health technology assessment (HTA) in Spain.Methods: A survey to summarize the evolution of HTA was sent to representatives of different HTA initiatives in Spain.Results: HTA was introduced in the late 1980s. The main factors were the trend to an increase in healthcare expenditure, concerns regarding efficiency in providing health care, as well as in the level of rationality introducing high technology. Spain has direct (i.e., regulation) and indirect (i.e., payment systems, evidence-based programs, HTA) mechanisms to control health technologies. A recent high priority regulation has established the need of HTA to decide the introduction of a new health technology in the lists of public healthcare coverage, although similar regulations existed in the past and were scarcely implemented. HTA initiatives started at the regional government level. Its introduction followed a progressive pattern among regions. In the beginning, resources were scarce and expertise limited, with work done at intramural level. With time, expertise increase, and promotion of commissioned work was implemented. HTA knowledge transfer in the healthcare system has been carried out through courses, publications, and commissioned research. Currently, there are seven HTA units/agencies, which coordinate their work.Conclusions: HTA in Spain is in its maturity. Facing the unavoidable change of health care environment over time, HTA is also evolving and, currently, there is a trend to broaden the areas of influence of HTA by devolving capacity to hospitals and applying principles to very early phases of health technology development, under the umbrella of regional HTA units/agencies. However, there are two main challenges ahead. One is to have a real impact at the highest level of healthcare policy coordination among Spanish regions, which is done at the Central Ministry of Health. The other is to avoid the influence of political waves in the level of recognition of HTA at the policy decision-making level and to have an adequate and stable funding of HTA initiatives.

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PATIENT AND PUBLIC INVOLVEMENT IN SCOPE DEVELOPMENT FOR A PALLIATIVE CARE HEALTH TECHNOLOGY ASSESSMENT IN EUROPE

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2014-000654.113 ◽

2014 ◽

Vol 4 (Suppl 1) ◽

pp. A40.3-A41 ◽

Cited By ~ 1

Author(s):

Louise Brereton ◽

Elizabeth Goyder ◽

Christine Ingleton ◽

Clare Gardiner ◽

Jim Chilcott ◽

...

Keyword(s):

Palliative Care ◽

Health Technology Assessment ◽

Technology Assessment ◽

Public Involvement ◽

Health Technology ◽

Patient And Public Involvement ◽

Care Health

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Organisational models of health services for children and adolescents in out‐of‐home care: Health technology assessment

Acta Paediatrica ◽

10.1111/apa.15002 ◽

2019 ◽

Vol 109 (2) ◽

pp. 250-257

Author(s):

Tita Mensah ◽

Anders Hjern ◽

Kickan Håkanson ◽

Pia Johansson ◽

Ann Kristine Jonsson ◽

...

Keyword(s):

Health Services ◽

Home Care ◽

Health Technology Assessment ◽

Children And Adolescents ◽

Technology Assessment ◽

Health Technology ◽

Out Of Home Care ◽

Care Health

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Special Section: Assessing Information Technologies for Health: Health Technology Assessment

Yearbook of Medical Informatics ◽

10.1055/s-0038-1638474 ◽

2006 ◽

Vol 15 (01) ◽

pp. 16-19

Author(s):

E. Ammenwerth ◽

Keyword(s):

Health Care ◽

Health Technology Assessment ◽

Technology Assessment ◽

Health Informatics ◽

Information Technologies ◽

Special Section ◽

Health Technology ◽

Unintended Effects ◽

Excellent Research ◽

Study Designs

SummaryTo summarize current excellent research in the field of health technology assessment.Synopsis of the articles selected for the IMIA Yearbook 2006.Five excellent articles representing the research in four different nations were selected for the IMIA Yearbook 2006 from three international peer reviewed journals.The best paper selection for the Yearbook section ‘Assessing Information Technologies for Health’ presents papers evaluating the benefit and side-effects of information technology in various settings. They clearly indicate that benefit of IT in health care can be achieved when the systems are appropriately designed, implemented and operated. Besides the presented quantitative studies, also qualitative study designs are of value to find unintended effects of IT, or to better explain found effects. IT evaluation supports a reflective practice on how health informatics influences health care, enabling the emergence of an evidence-based health informatics.

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OP04 Lessons Learnt When Implementing A Health Technology Assessment Institution In Costa Rica

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462317001155 ◽

2017 ◽

Vol 33 (S1) ◽

pp. 3-4

Author(s):

Iñaki Gutiérrez-Ibarluzea ◽

James Cercone ◽

Daniel Bronstein ◽

Luis Tacsan ◽

Pablo Morales ◽

...

Keyword(s):

Health Care ◽

Costa Rica ◽

Social Security ◽

Health Technology Assessment ◽

Health System ◽

Technology Assessment ◽

Access To Health Care ◽

Health Technology ◽

Right To Health ◽

Independent Evidence

INTRODUCTION:Faced with increasing financial challenges to the single-payer social security system and constitutional challenges supporting all citizen's right to health, Costa Rica has endeavored to introduce Health Technology Assessment (HTA) to ensure sustainability and promote the timely introduction of technology innovations in the health system. The Ministry of Health initiated a process to establish an independent, external institution providing leadership in the process of HTA.METHODS:Based on a survey developed by REDETSA/PAHO (HTA Network of the Americas/Pan American Health Organization), an inclusive method of stakeholders participation was used to analyze the strengths, weaknesses, opportunities and threats regarding the implementation of an HTA entity. This was combined with qualitative research methods, market access situation analysis and the review of coverage and provision processes to define the elements for the new HTA institution. The “in-depth” interviews extended to manufacturers, ministry representatives, services providers, purchasers, patients and citizens representatives, judiciary court, professional colleges, academia and non-governmental organizations (NGOs). Analysis of the professional competencies required for the HTA institution was carried out based on best practice analysis of international HTA institutions.RESULTS:The implementation of an HTA unit in Costa Rica was identified by all the actors as crucial to ensuring the health system's sustainability. Costa Rica's health system is based on all citizens right to health and all inputs required delivering health services, judicialization and access to health care have become a big issue. Two main issues were identified as essential to implement an HTA institution: the establishment of a clear framework to provide legal and financial support and the need to have sufficient independence from the Ministry and the Social Security, including maximum transparency and methodological robustness.CONCLUSIONS:The business model for the new HTA institution should consider the participation of all the interested actors. The HTA institution should bridge the gap between technology regulation and health technology management and aim to improve both processes. It should also provide third party independent evidence to inform the constitutional court around health care claims.

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