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

OHE Consulting Report for PhRMA
5 January 2011
We noted from the literature reviews conducted that many health systems typologies exist (see
Section 2). While the purpose of these taxonomies is to usually describe health systems, developing
these classification systems is unavoidably normative: which categories are selected relies on
researcher value judgements, which will be influenced by prior beliefs about what is important, and
by what question is being asked and so forth. Taxonomies are ‘stylised models’ of the real world and
there is a tension between keeping it simple (to enable comparisons and contrasts to be drawn) and
the ability of such models to provide an adequate account of the reality of any given health care
system.
The health system taxonomy we propose is highly stylised: it focuses on just two criteria we
hypothesise are most likely directly to relate to the evolution of approaches to HTA: the level of
spending, and the degree of centralisation in decision making. The HTA taxonomy also comprises
two criteria: which technologies are appraised; and what that appraisal process is concerned with.
7.2 The health care system typology
Our health care system typology is depicted in Figure 8 below.
Figure 8: Health care system typology: two key attributes/variables and levels
LEVEL OF SPEND
What quantity of resources are
available?
Low spend per capita
Medium spend per capita
High spend per capita
DEGREE OF CENTRALISATION
Who makes decisions about what
health care is funded?
Out of pocket spend dominates
Emergence of insurance
/collective funding; decisions
localised
Active third party purchasing
Level of spend is readily understandable. It inevitably shapes the nature and priorities of the health
care system. By the “degree of centralisation” we are combining two related but distinct features of
the financing arrangements for an evolving health care system:
1. The extent to which there is third party coverage and so an interest in the use of both
“micro” and “macro” technologies that goes beyond the provider-­‐patient relationship that
dominates an out-­‐of-­‐pocket spend environment.
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