The Evolution of HTA in Emerging Markets Health-Care ... - TREE

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OHE Consulting Report for PhRMA 5 January 2011 typology developed was based on the following criteria: first, what group of people does the national healthcare system protect, i.e., is it all citizens, the vulnerable or some pre-‐specified group of insured individuals? The second is: which sector is the main provider of healthcare, i.e., is it public or private? The third is: is there state intervention in the financing of healthcare, and if there is, is it concentrated or dispersed? Using two main dimensions: (1) financing administration, and (2) provision of healthcare, Lee, et al. (2008), describe a health system as NHS if financing administration is single or concentrated and if provision of healthcare is ‘public’. A health system is characterised as NHI if financing administration is single/concentrated and if there is private provision of healthcare. A health system is characterised as SHI if financing administration is multiple/dispersed and provision of healthcare is ‘public’. Finally, a health system is characterised as a ‘Liberal model’ if financing administration is private and there is private provision of healthcare. Lee, et al (2008) use their typology to classify the healthcare system in Taiwan and South Korea by adding in a fourth criterion of ratio of public to total healthcare expenditure and the ratio of public hospital beds to total hospital beds. 5.6 Weberian taxonomy of health systems One other classification system we identified is that by Wendt, et al. (2009). In brief, their approach is based on what is called the Weberian method of ‘ideal types’, which is a tool used for comparative research of welfare regimens. The ideal-‐type ‘is formed by one-‐sided accentuation of one or more points of view and by the synthesis of a great many diffuse, discrete, more or less present and occasionally absent concrete individual phenomena…’ This welfare regimen analyses is meant to identify the ‘ideal-‐typical’ case that is, roughly speaking the type of health system that is commonly observed. On the basis of this framework, Wendt, et al. (2009) identified 27 types of healthcare systems; there are three instances of ‘ideal types’ in which there is uniformity in all dimensions (1. finance, 2. service provision and 3. regulation/governance). These are pure state healthcare systems, societal healthcare systems and private healthcare systems. For each ideal-‐type, there are six combinations of mixed types in which identical features can be seen in two of the three dimensions. In six other combinations of mixed types, there is no uniformity in any of the dimensions; these are referred to as pure mixed-‐types. Their classification is rather complex and over-‐elaborate and not helpful for our work. 5.7 WHO’s ‘single’ framework To the best of our knowledge, the most recent healthcare classification system is what WHO (2007) calls a ‘single framework with six building blocks’ to promote understanding of what a health system is and what constitutes health system strengthening. These building blocks highlight the basic functions of health systems (regardless of how they are organized). The six building blocks shown in Figure 4, which have some similarity to the features of Figure 2, are: Service delivery. This captures issues relating to the delivery of effective, safe and quality personal and non-‐personal health interventions (with the minimum waste of resources) 28
OHE Consulting Report for PhRMA 5 January 2011 Health workforce. A good health system is one that employs a well-‐performing health workforce in ways that are fair and efficient to achieve the best health outcomes possible, i.e., there should be sufficient quantity of health staff that is competent, responsive, productive and fairly distributed Health information systems. Having well-‐functioning information systems is needed to ensure reliable and timely production, analysis and dissemination of information on health determinants, health system performance and health status Medical products, vaccines and technologies. A key, basic objective of health systems is to ensure equitable access to medical products, vaccines and technologies of assured quality, safety and efficacy (and cost-‐effectiveness) as well as ensuring their use is scientifically sound and cost effective Healthcare financing. A good health system should have means of raising adequate funds for healthcare (and health) provision in ways that ensure people can use needed services and are protected from the financial risks of ill healthcare demands (and the impoverishment associated with having to pay for these demands) Leadership and governance (stewardship). This focuses on the development (and existence) of strategic policy frameworks that are combined with effective oversight, coalition-‐building, regulation, attention to system-‐design and accountability. WHO’s six-‐building-‐blocks framework seems to be the most recent framework to have to been developed for classification and understanding the functions of healthcare systems. It places special emphasis on medical products, vaccines and technologies (and separates it from health workforce). This building block framework is particularly relevant as it focuses on promoting equitable access and rational use of medical products and health technologies which fits with one objective of HTA which is to resolve uncertainty about the value of health technologies and their appropriate use in the delivery of medical care. Figure 4: Six building blocks of a health system: WHO (2007) 29
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The Evolution of HTA in Emerging Markets Health-Care ... - TREE

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