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

OHE Consulting Report for PhRMA
5 January 2011
Table of Contents
EXECUTIVE SUMMARY ..................................................................................................................................... 6
CATEGORISING AND APPLYING HEALTH CARE SYSTEM FRAMEWORKS .............................................................................. 7
CATEGORISING AND APPLYING HTA FRAMEWORKS ..................................................................................................... 8
A CONCEPTUAL MODEL OF HTA IN RELATION TO HEALTH CARE SYSTEMS ........................................................................ 9
The focus of HTA: what is the appraisal concerned with? ....................................................................... 10
The Breadth of HTA: Which Health Technologies are Appraised? ........................................................... 11
Level of Spend .......................................................................................................................................... 11
The degree of centralisation .................................................................................................................... 11
LESSONS FOR THE THREE MARKETS IN THE CONTEXT OF THE MODEL ............................................................................. 12
OPTIONS FOR THE DEVELOPMENT OF HTA IN THE THREE MARKETS ................................................................................ 13
ISSUES FOR PHRMA IN DEVELOPING PUBLIC POLICY POSITIONS..................................................................................... 15
1 INTRODUCTION AND CONTEXT .......................................................................................................... 17
1.1 PURPOSE OF THIS REPORT ......................................................................................................................... 17
1.2 STRUCTURE OF THIS REPORT ..................................................................................................................... 17
1.3 ACKNOWLEDGEMENTS ............................................................................................................................. 18
2 TERMS OF REFERENCE ....................................................................................................................... 19
3 OUR APPROACH ................................................................................................................................ 20
3.1 WORKSTREAMS ...................................................................................................................................... 20
3.1.1 Workstream 1: Categorisation of health care systems ............................................................... 20
3.1.2 Workstream 2: Categorisation of HTA ........................................................................................ 20
3.1.3 Workstream 3: Mapping HTA onto health care systems in emerging economies ...................... 21
3.1.4 Workstream 4: Developing options for HTA development in the three countries ....................... 21
3.2 PROJECT STEERING GROUP ....................................................................................................................... 22
3.3 DELIVERABLES ........................................................................................................................................ 23
4 HEALTH SYSTEMS CATEGORISATION ................................................................................................. 24
4.1 LITERATURE SEARCH STRATEGY .................................................................................................................. 24
4.2 TYPES OF HEALTHCARE PAYERS (INSURERS) .................................................................................................. 24
4.3 FUNCTIONS OF HEALTH SYSTEMS ................................................................................................................ 25
4.4 FUNCTIONS AND GOALS OF HEALTH SYSTEMS ................................................................................................ 27
4.5 A 3-­‐MODEL TYPOLOGY OF HEALTH SYSTEMS ................................................................................................. 27
4.6 WEBERIAN TAXONOMY OF HEALTH SYSTEMS ................................................................................................ 28
4.7 WHO’S ‘SINGLE’ FRAMEWORK .................................................................................................................. 28
4.8 APPLYING HEALTH CARE SYSTEM FRAMEWORKS ........................................................................................... 30
5 CATEGORISATION OF HEALTH TECHNOLOGY ASSESSMENT (HTA) SYSTEMS ...................................... 32
5.1 LITERATURE SEARCH STRATEGY .................................................................................................................. 32
5.2 SOME RELEVANT LITERATURE FOR HTA CLASSIFICATION ................................................................................. 32
5.3 WHERE DOES HTA FIT INTO THE HEALTHCARE SYSTEM? ................................................................................. 36
5.4 A DYNAMIC PERSPECTIVE TO HTA DEVELOPMENT ......................................................................................... 38
5.5 APPLYING HTA FRAMEWORKS .................................................................................................................. 39
6 OUR CONCEPTUAL MODEL FOR UNDERSTANDING HTA IN EMERGING MARKETS .............................. 41
6.1 DEVELOPING THE CONCEPTUAL MODEL ....................................................................................................... 41
6.2 THE HEALTH CARE SYSTEM TYPOLOGY ......................................................................................................... 42
6.3 CONSIDERING THESE TYPOLOGIES TOGETHER ................................................................................................ 43
6.3.1 The breadth of HTA: which health technologies are appraised? ................................................. 44
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