The Evolution of HTA in Emerging Markets Health-Care ... - TREE
The Evolution of HTA in Emerging Markets Health-Care ... - TREE
The Evolution of HTA in Emerging Markets Health-Care ... - TREE
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OHE Consult<strong>in</strong>g Report for PhRMA<br />
5 January 2011<br />
4 Our Approach<br />
4.1 Workstreams<br />
To fulfil the study objectives we have divided the work <strong>in</strong>to four separate, <strong>in</strong>terrelated, workstreams.<br />
4.1.1 Workstream 1: Categorisation <strong>of</strong> health care systems<br />
We started our analysis with a classification <strong>of</strong> health care systems to help understand the roles <strong>of</strong><br />
payers – dist<strong>in</strong>guish<strong>in</strong>g between a s<strong>in</strong>gle national/public payer and multiple private payers/<strong>in</strong>surers –<br />
and the roles <strong>of</strong> doctors and patients <strong>in</strong> the f<strong>in</strong>al choice <strong>of</strong> treatments and/or the management <strong>of</strong><br />
disease.<br />
To do this we did the follow<strong>in</strong>g:<br />
1. Reviewed relevant literature <strong>in</strong>clud<strong>in</strong>g reports published by the World <strong>Health</strong> Organization<br />
(WHO), Organisation for Economic Co-‐operation and Development (OECD), World Bank, and<br />
academic groups such as <strong>The</strong> European Observatory on <strong>Health</strong> Systems and Policies (which<br />
produces country pr<strong>of</strong>iles for western Europe, central and eastern Europe and the central<br />
Asian republics);<br />
2. Identified <strong>in</strong> the literature review references to the three countries <strong>of</strong> particular <strong>in</strong>terest <strong>in</strong><br />
the study -‐ Brazil, Ch<strong>in</strong>a and Taiwan;<br />
3. Developed possible ‘evolutionary pathways’ that countries are <strong>in</strong> pr<strong>in</strong>ciple follow<strong>in</strong>g <strong>in</strong> an<br />
attempt to improve their health care systems as <strong>in</strong>come per-‐capita <strong>in</strong>creases. <strong>The</strong>re are<br />
several different start<strong>in</strong>g po<strong>in</strong>ts and potential pathways, but from a dynamic viewpo<strong>in</strong>t it is<br />
possible to identify the key trends.<br />
In the second part <strong>of</strong> the project we used the theoretical framework to review the experience <strong>of</strong> the<br />
three countries.<br />
4.1.2 Workstream 2: Categorisation <strong>of</strong> <strong>HTA</strong><br />
Based on the experience <strong>of</strong> developed countries and current policy and academic debate <strong>in</strong> Europe<br />
and North America, we set out to analyse different def<strong>in</strong>itions and approaches to <strong>HTA</strong> (e.g.<br />
decentralised versus centralised, compar<strong>in</strong>g effectiveness versus cost-‐effectiveness) to understand<br />
how <strong>HTA</strong> can work <strong>in</strong> different sett<strong>in</strong>gs and how it has worked <strong>in</strong> practice <strong>in</strong> a number <strong>of</strong> countries...<br />
In our literature reviews for Workstreams 1 and 2, we searched for and reviewed published<br />
literature, <strong>in</strong>clud<strong>in</strong>g papers and reports commissioned or conducted by key <strong>in</strong>ternational<br />
organisations that are <strong>in</strong> the public doma<strong>in</strong> but are not part <strong>of</strong> the peer-‐reviewed journal literature<br />
(the so-‐called grey literature). Our approach was not meant to be exhaustive or comprehensive: we<br />
followed a selective approach ma<strong>in</strong>ly driven by:<br />
20