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

OHE Consulting Report for PhRMA
5 January 2011
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Consider country-­‐specific evidence and issues in HTA in relation to the conceptual
framework described earlier in Section 6;
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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.
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