Abstract
Countries around the world are increasingly rethinking the design of their health benefit packages to achieve universal health coverage (UHC). Health technology assessment (HTA) bodies support governments in these decisions, but employ value frameworks that do not sufficiently account for the intrinsically complex and value-laden political reality of benefit package design. Several years ago, evidence-informed deliberative processes (EDPs) were developed to address this issue. An EDP is a practical and stepwise approach for HTA bodies to enhance legitimate health benefit package design based on deliberation between stakeholders to identify, reflect and learn about the meaning and importance of values, and to interpret available evidence on these values. We further developed the conceptual framework and initial 2019 guidance based on academic knowledge exchange, analysing practices of HTA bodies, surveying HTA bodies and experts around the globe, and implementation of EDPs in several countries around the world. EDPs stem from the general concept of legitimacy, which is translated into four elements - stakeholder involvement ideally operationalised through stakeholder participation with deliberation; evidence-informed evaluation; transparency; and appeal. The 2021 practical guidance distinguishes six practical steps of a HTA process and provides recommendations on how these elements can be implemented in each of these steps. There is an increased attention for legitimacy, deliberative processes for HTA and health benefit package design, but the development of theories and methods for such processes remain behind. The added value of EDPs lies in the operationalisation of the general concept of legitimacy into practical guidance for HTA bodies.
Highlights
Countries around the world are increasingly rethinking the design of their health benefit packages to support the progressive realisation of universal health coverage (UHC), ie, to select the appropriate set of services at fair levels of coverage and financial protection.[1,2,3] Many countries have established health technology assessment (HTA) bodies to support governments in these choices.[4]
An Evidence-informed deliberative processes (EDPs) is a practical and stepwise approach for HTA bodies to enhance legitimate health benefit package design based on deliberation between stakeholders to identify, reflect and learn about the meaning and importance of values, and to interpret available evidence on these values
This paper reports on the further development of EDPs with an emphasis on the key concept of stakeholder participation with deliberation
Summary
Implications for the public Countries need to make important decisions as to which health technologies are included in the health benefit package. This often takes place without involvement of relevant stakeholders, eg, specific population groups who bear the consequences of decisions such as patients, the public and health professionals. Important stakeholders values and knowledge may be ignored, and resulting decisions may not reflect societal preferences. Evidence-informed deliberative processes (EDPs) are developed to support counties to address this issue by improving the legitimacy, or fairness, of its decision-making process. Core element is the organisation of stakeholder participation in which eg, patients, health professional and the public deliberate and interact with policy-makers on benefit package design
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