Health Technology Assessment as a Priority-Setting Tool for Universal Health Coverage: The Call for Global Action at the Prince Mahidol Award Conference 2016.

Abstract

Imagine you are a decision maker in a country that has committed to universal health coverage (UHC). Your government will provide health services to your constituents according to their needs but regardless of their ability to pay. You are part of the committee deciding what services should be provided to whom and at what cost— this is called the Health Benefits Package. Since your country, similar to all others, has limited health resources and cannot offer every service available, especially highcost ones, it is necessary for you to set priorities within and across health problems and for different groups of populations, which is a difficult task. This situation happens to decision makers in many countries, given that 75 countries have now legislated UHC [1]. Surprisingly, there is relatively little guidance and experience sharing in the existing literature on health benefits package development (i.e. searching from PubMed using the keywords ‘‘health benefits package’’ and ‘‘health basket’’ yielded only 16 and 17 hits, respectively). Moreover, decision makers’ work nowadays is likely to be more difficult than it was 50 years ago, when only one or a few treatment choices were available for each disease and at relatively low cost. For example, only one option was available for adjuvant therapy for stage III colon cancer in 1989 [2], but there are now nine choices in the recent evaluation, of which the most expensive treatment regimen has a medicine price that is 32 times higher than the least expensive alternative [3]. Decisions for healthcare become more complex with UHC. In the past, doctors advised patients based on clinical benefit, while patients chose their treatment options based on ability to pay. In this situation, doctors recognise patients’ limitations in selecting treatments. However, with UHC, the doctor and patient are no longer responsible for directly paying for treatments—there is now a third party, the government, which manages decisions on a higher level for the whole healthcare system. The doctor and the patient disregard the cost limitations and often require the best treatment, thus together putting pressure on those making decisions. Doctor–patient collaboration sparks media interest, and is also supported by industry, another player, which aim to have their products included in the benefits package in order to guarantee procurement in large quantities. As such, the government requires a robust process and evidence in order to ensure that the health benefits package decisions are systematic, transparent and acceptable to all stakeholders. Experience from countries such as Australia, Canada, Thailand and the UK indicates that health technology assessment (HTA), a ‘‘multidisciplinary policy research, in generating evidence to inform prioritization, selection, introduction, distribution, and management of interventions for health promotion, disease prevention, diagnosis and treatment, and rehabilitation and palliation’’, can be helpful in supporting this purpose [4–7]. In Thailand and the UK, in particular, decision makers not only successfully include interventions in their benefits packages but are also able to decline including unnecessarily costly or unproven interventions as well as set standards for other countries in the regions. & Alia Luz alialuz90@gmail.com; alia.l@hitap.net