With changing population demographics and rising healthcare expenditures, countries have increasingly turned to the utilization of Health Technology Assessment (HTA) to distribute resources and control costs while offering the highest quality healthcare. HTA promotes evidence-based decisions on efficiently allocating resources. It focuses on the clinical and cost effectiveness of technologies, social values, ethical implications, and a range of other considerations. But, what drives countries to incorporate HTA into their healthcare coverage decision-making scheme? And, what barriers stand in the way?
Many countries have decades of experience with HTA before the government officially integrates it into the healthcare system’s price setting, reimbursement, or healthcare funding scheme. Yet, few studies have examined comprehensively the various political, socio-cultural, scientific, and legal influences that bring governments to their tipping points, deciding to formally incorporate HTA into their decision making process.
In order to determine those influences, iDSI, the Global Health and Development Group based within the Institute of Global Health Innovation at Imperial College London (previously NICE International), and the World Bank came together to investigate the major driving forces motivating HTA adoption – and the major barriers preventing it. This working paper studies England and Wales, Thailand, Poland, and Japan to investigate how each country incorporated (or is working to incorporate) HTA into the broader healthcare system, and the influences that drive adoption.
The political and social structures of England and Wales, Thailand, Japan, and Poland vary greatly, as do the forces influencing how and why each country adopted HTA. England and Wales officially adopted HTA when NICE was established as a mechanism for explicit—rather than implicit—rationing of healthcare services to reduce regional disparities in health services. Thailand has a long history with HTA; however, HTA was formally adopted when the government appointed the HTA Agency, HITAP, to a gate-keeping secretarial role in addition to its role conducting technology assessments. AOTM (now AOTMiT), the Polish Health Technology Assessment Agency, was formally established in 2005. Japan has not yet officially adopted HTA, but it is actively piloting the integration of one component of HTA—pharmacoeconomic evaluation—into its national fee-schedule for pricing reimbursement of pharmaceuticals.
This paper explores the similarities and differences across each country’s experience and it seeks to explore the valuable question: how do countries adopt HTA and what obstacles must they prepare to overcome?
Rebecca Dittrich is a Juris Doctorate Candidate at Georgetown University Law Center and Masters of Public Health Candidate at Johns Hopkins Bloomberg School of Public Health.