Technology assessment and coverage policy: the case of invasive cardiology therapy in 5 European countries

Bos M, Carlsson P, Kooij S, Liaropoulos L, Sampietro-Colom L, Schilling J
Record ID 31998008638
Catalan, English, Spanish
Authors' objectives:

To find out what factors influence coverage policy decisions, in particular the availability of studies with the intention of influencing coverage policies, such as health technology assessment (HTA) reports, in the various countries of the European Economic Space. This has been done by tacking the main research question: do HTA studies on invasive cardiology therapy (ICT) have any effect on coverage policy decisions?

Authors' results and conclusions: Third party payers from the countries analyzed use both direct (laws, recommendations) and indirect (financing methods) mechanisms to influence the introduction and diffusion of health technologies. These countries use different measures to yield both mechanisms effective (e.g. co-payment, planning, etc.). Two out of the five analyzed countries have specific regulations which require the evidence of some of the criteria used in HTA process for the coverage of health technologies and, therefore, of ICT (Catalonia and Switzerland). Another country (the Netherlands) is at present developing a regulation as regards this. Two out of the five countries analyzed have developed recommendations about the introduction and diffusion of ICT technologies (Greece and Sweden). These recommendations are followed in different ways. The main financing sources for health care and, therefore, for the ICT procedures are taxes (Catalonia and Sweden) and compulsory insurance fees (Switzerland and the Netherlands). Greece has very high percentage of private coverage. The financing mechanisms used in the provision of ICT are global budgets (Catalonia, Greece and the Netherlands), and the existence of specific budgets for ICT (Catalonia and the Netherlands). In its beginnings, the introduction of ICT technologies was limited to university hospitals. However, its diffusion has not been the same, as regards both rate and volume of the adoption and its distribution among the health care centres of different level of complexity. Among the new ICT technologies, stents are experiencing the highest diffusion among the countries analyzed. The availability of assessment studies of ICT technologies is present in three out of the four countries which have a settled, long-experienced assessment organism (Catalonia, Sweden and the Netherlands). Most assessment studies about ICT technologies identified, carried out by official organisms refer to needs and planning issues, therefore addressing coverage policies decisions. Most of the studies have had some effect in services planning.
Authors' recommendations: The cross-country case-study shows that the type of health care system (Social Security, National Health System) does not seem to be a determining factor in the introduction and diffusion of ICT technologies. Neither is to belong to the North or the South of Europe. There is no uniform system, and no single source of information, for the establishment of ICT coverage policy decisions. The information provided by HTA studies represents just one tool in a group of interacting forces. Individual physicians, medical professional bodies, medical advisory boards and patients have also an important role in coverage decisions concerning ICT. The weight of these different forces varies depending on the country context regarding health care system (organization, quality and quantity of structural resources...) and cultural values. The availability of a structure for HTA is an important prerequisite for those HTA studies to have any impact on coverage policy decisions. This implies: to get provision of funds by third-party payers, to have a well-structured and explicit process of evaluation, and to focus on policy aims with a scientific frame of reference.
Authors' methods: Technology assessment
Project Status: Completed
Year Published: 1996
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: Spain
MeSH Terms
  • Coronary Artery Bypass
  • Technology Assessment, Biomedical
  • Myocardial Infarction
Organisation Name: Agencia de Qualitat i Avaluacio Sanitries de Catalunya
Contact Address: Antoni Parada, CAHTA, Roc Boronat, 81-95 (2nd floor), 08005 Barcelona, Spain, Tel. +34 935 513 928, Fax: +34 935 517 510
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Copyright: Catalan Agency for Health Technology Assessment and Research
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.