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

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OHE Consulting Report for PhRMA 5 January 2011 9 What role does HTA have in emerging markets? Lessons from Brazil, Taiwan, and China 9.1 The Three Markets in the Context of the Model The objectives of this project, as noted in Section 1, were to produce (i) a categorisation of health care systems and (ii) a categorisation of types of HTA relevant to policy development in the evolving health care systems of low and middle income countries. In Section 6, we proposed simplified taxonomies of health care systems and of HTA approaches, and combined these to provide an overall conceptual model which is summarised in Figure 11 below: Figure 11: A Conceptual Model of Health Care Systems and HTA In this section, we draw on the detailed case studies on Taiwan, China, and Brazil included in the Appendices and summarised in Section 7 to: -‐ Identify common themes and issues across these health care systems with respect to their evolving use of HTA; 56
OHE Consulting Report for PhRMA 5 January 2011 -‐ Consider country-‐specific evidence and issues in HTA in relation to the conceptual framework described earlier in Section 6; -‐ -‐ Critically assess the extent to which there are generalisable conclusions, i.e., lessons, about the role of HTA in emerging markets, and what the limits to those conclusions might be; Offer conclusions about how HTA might most usefully evolve in each system, and whether there are generalisable recommendations regarding HTA in emerging markets. We can see from the Tables and from our analysis that the three countries can be categorised as follows with respect to level of spend and degree of centralisation. Level of spend In each of the three countries examined in this report, their economic status as emerging markets is matched by, and reflected in, the development of their health systems to meet the growing expectations about and demands for health care and health. Brazil is spending around 8% of GDP on health as compared to 4% for China and 6% for Taiwan. Brazil is closest to the OECD average of 10% in 2008 (OECD Health Database, 2010). China is seeking to increase spending on health rapidly to around 6% of GDP. The development of health care systems in these economies comprises, with varying degrees of speed and ambition, movements toward greater national coordination and consistency – i.e. a planned health system, emerging from the diverse, localised arrangements that characterise lesser developed countries. Especially in the larger emerging markets, such as Brazil and China, this process represents a very considerable challenge. In part, the evolution of health care systems in emerging markets (and the speed with which that takes place) reflects the pace of development of better infrastructure more generally in these economies. The rapid economic growth and development of these economies is, of course, also a facilitator for the development of the health care system: industrialisation leads to more economic activity being channelled into the formal economy, increasing the potential tax base; and economic growth generates increases in taxation revenue generated from any given tax base. Together these factors make it possible, in principle, to increase the supply of collectively-‐funded health care and to reduce the reliance on out-‐of-‐pocket payments. Each of the three health care systems examined in this report are, to some extent, working toward increasing universality -‐ that is, increasing the share of the population covered by these schemes (although the starting points in each case are very different). Each is also struggling (in different ways) to reconcile rapidly rising expectations regarding health care with what is currently available in health care terms given available budgets. HTA represents one means by which these tensions may be reconciled – although where, as appears to be the case in Brazil, limits on the resources to conduct the reviews result in substantial delays in access, which is unlikely to be a satisfactory response in the longer term. 57
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