Abstract
ObjectivesThis study aimed to identify the barriers and facilitators to improve the use of health technology assessment (HTA) for the selection of medicines listed in the e-Catalogue and the national formulary in Indonesia.MethodsSemi-structured interviews were conducted to collect qualitative data. Purposive sampling was used to recruit the stakeholders consisting of policymakers, a pharmaceutical industry representative, healthcare providers, and patients. The data were analyzed using directed content analysis and following the COnsolidated criteria for REporting Qualitative studies (COREQ).ResultsThe twenty-five participants interviewed agreed with the use of HTA for supporting the e-Catalogue and the national formulary and perceived the advantages of HTA implementation outweighed the disadvantages. Barriers mentioned were a lack of capability of local human resources, financial incentives, a clear framework and insufficient data. Strategies suggested to overcome the barriers were establishing (inter)national networks to build up capacity, setting up departments of HTA in several universities in Indonesia, and introducing a clear HTA framework. Facilitators mentioned were the ambition to achieve universal health coverage, the presence of legal frameworks to implement HTA in the e-Catalogue and the national formulary, and the demands for appropriate medicine policies.ConclusionsSeveral barriers are currently hampering broad implementation of HTA in medicine pricing and reimbursement policy in Indonesia. Solutions to these issues appear feasible and important facilitators exist.
Highlights
The twenty-five participants interviewed agreed with the use of health technology assessment (HTA) for supporting the eCatalogue and the national formulary and perceived the advantages of HTA implementation outweighed the disadvantages
The 2015 transition from Millenium Development Goals to Sustainable Development Goals has triggered a shift in global health from service-specific targets to broader health system goals [1]
In low middle-income countries (LMICs), the proportion of out-of-pocket payments in healthcare expenditures is still high, for medicines, the number ranges from 50% to 90% [5]
Summary
The 2015 transition from Millenium Development Goals to Sustainable Development Goals has triggered a shift in global health from service-specific targets to broader health system goals [1]. Target 3.8 of the Sustainable Development Goals explicitly states to achieve Universal Health Coverage (UHC) [2]. The presence of UHC ideally will reduce or eliminate the proportion of out-of-pocket payments from healthcare expenditures [3]. Out-of-pocket payment, a direct payment to the healthcare providers at the time of service use, can drive an individual or a household below the poverty line [4]. In low middle-income countries (LMICs), the proportion of out-of-pocket payments in healthcare expenditures is still high, for medicines, the number ranges from 50% to 90% [5]
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