Evidence-Informed Deliberative Processes for Health Benefit Package Design - Part II: A Practical Guide.

Wija Oortwijn,Maarten Jansen,Rob Baltussen

doi:10.34172/ijhpm.2021.159

Abstract

Countries around the world are using health technology assessment (HTA) for health benefit package design. Evidence-informed deliberative processes (EDPs) are a practical and stepwise approach to enhance legitimate health benefit package design based on deliberation between stakeholders to identify, reflect and learn about the meaning and importance of values, informed by evidence on these values. This paper reports on the development of practical guidance on EDPs, while the conceptual framework of EDPs is described in a companion paper. The first guide on EDPs (2019) is further developed based on academic knowledge exchange, surveying 27 HTA bodies and 66 experts around the globe, and the implementation of EDPs in several countries. We present the revised steps of EDPs and how selected HTA bodies (in Australia, Brazil, Canada, France, Germany, Scotland, Thailand and the United Kingdom) organize key issues of legitimacy in their processes. This is based on a review of literature via PubMed and HTA bodies' websites. HTA bodies around the globe vary considerable in how they address legitimacy (stakeholder involvement ideally through participation with deliberation; evidence-informed evaluation; transparency; and appeal) in their processes. While there is increased attention for improving legitimacy in decision-making processes, we found that the selected HTA bodies are still lacking or just starting to develop activities in this area. We provide recommendations on how HTA bodies can improve on this. The design and implementation of EDPs is in its infancy. We call for a systematic analysis of experiences of a variety of countries, from which general principles on EDPs might subsequently be inferred.

Highlights

Evidence-informed deliberative processes (EDPs) provide a practical stepwise approach for health technology assessment (HTA) bodies to improve the legitimacy of their decision-making processes
It is hereby important to recognise that the EDPframework is a holistic approach to enhance legitimacy, even though its terminology may suggest a narrow focus on deliberation
The overall concept of EDPs stems from the general principle of legitimacy, the definition of four elements is a practical translation of the Accountability for Reasonableness framework,[5] the definition of practical steps is based on existing HTA methods and tools, whereas related recommendations on best practices are inferred from observed practices of HTA bodies around the world

Summary

Background

Countries around the world are rethinking the design of their health benefit packages to achieve universal health coverage.[1,2,3] Many countries have established health technology assessment (HTA) bodies which support governments in these choices.[4]. Development of Practical Guidance In his commentary on EDPs, Culyer describes the development of deliberative processes: “the understanding how best to make arrangements (..) immediately takes one to a highly complex academic and professional crossroads of behavioural science, governance, political philosophy, political science, the law, administrative theory, industrial economics and communications This lattice of disciplines and professions militates against there being any single unifying ‘theory of deliberative processes’ so one needs to add other requirement: imagination and descriptive evidence. The overall concept of EDPs stems from the general principle of legitimacy, the definition of four elements is a practical translation of the Accountability for Reasonableness framework,[5] the definition of practical steps is based on existing HTA methods and tools, whereas related recommendations on best practices are inferred from observed practices of HTA bodies around the world. EDPs Practical Steps: Recommendations and HTA Practices Around the Globe Step A Installing an Advisory Committee Role We advise HTA bodies to install an advisory committee

Monitoring and evaluation

Introduction

Findings

Discussion