Terugbetalingssystemen voor geneesmiddelen ... - Pharma

10 Drug Reimbursement Systems KCE Reports 147
The required strength of the relationship between the advice and the decision is a
political decision. Countries can choose to consider all socially relevant criteria in the
appraisal process, including the health care sector related and the non-health care
sector related criteria, in which case there is no reason to make a distinction between
the appraisal and decision making phase. Countries can also choose to give discretionary
power to the minister responsible for drug reimbursement decisions.
A graphical presentation of the different phases in a drug reimbursement decision
process, with for each phase our operational definition, is given in Table 2.
Table 2: Flow-chart of the reimbursement decision process
Assessment
phase
•Assessment criteria: health(care‐sector) related, measurable
•Objective reporting, no value judgement
•Output: Assessment report
Appraisal
phase
•Appraisal criteria: assessment criteria + other socially relevant
health(care‐sector) related criteria
•Weighing criteria, value judgement
•Output: Reimbursement advice
Decisionmaking
phase
•Decision criteria: appraisal criteria + other socially relevant criteria
•Weighing appraisal outcome with other socially relevant criteria,
value judgement
•Output: Reimbursement decision
1.5 STRUCTURE OF THE REPORT
Chapter two describes our findings regarding similarities and differences between the
Austrian, Belgian, Dutch, French, and Swedish drug reimbursement systems. The
chapter starts with setting the scene for the Hutton framework comparison (paragraph
2.1). It briefly describes the five health care systems and pharmaceutical policies to
define the context of each drug reimbursement system. Subsequently, we start using the
Hutton framework to compare the five drug reimbursement systems (paragraphs 2.2
and 2.3). In these sections we compare the reimbursement policies, the assessment,
appraisal and decision-making processes and the outputs and implementation of
decisions. For each of these framework elements, we evaluate how the systems are
governed, who are the involved key actors and what are the methods and processes
used. A summary of findings is presented in Table 5 to Table 9. More detailed
descriptions of the reimbursement systems in each country are provided in the
appendices, following the structure of the Hutton framework. The third chapter moves
beyond the descriptive Hutton framework and discusses the possible strengths and
weaknesses of reimbursement systems in terms of “accountability for reasonableness”.
This chapter also provides the final conclusions and general recommendations. In the
final chapter, we reflect on the issues in the current Belgian drug reimbursement system
as identified during the consultation rounds with the members of the Drug
Reimbursement Committee (CTG/CRM).