When health technology assessment is confidential and experts have no power: the case of Hungary

Marcell Csanádi, Olga Löblová, Piotr Ozieranski, Andras Harsányi, Zoltan Kalo, Martin McKee, Lawrence King

Research output: Contribution to journalArticle

7 Citations (Scopus)
16 Downloads (Pure)

Abstract

Health technology assessment (HTA) is not simply a mechanistic technical exercise as it takes place within a specific institutional context. Yet, we know little about how this context influences the operation of HTA and its ability to influence policy and practice. We seek to demonstrate the importance of considering institutional context, using a case study of Hungary, a country that has pioneered HTA in Central and Eastern Europe. We conducted 26 in-depth, semi-structured interviews with public and private sector stakeholders. We found that while the HTA Department, the Hungarian HTA organisation, fulfilled its formal role envisaged in the legislation, its potential for supporting evidence-based decision-making was not fully realised given the low levels of transparency and stakeholder engagement. Further, the Department’s practical influence throughout the reimbursement process was perceived as being constrained by the payer and policymakers, as well as its own limited organisational capacity. There was also scepticism as to whether the current operational form of the HTA process delivered “good value for money”. Nevertheless, it still had a positive impact on the development of a broader institutional HTA infrastructure in Hungary. Our findings highlight the importance of considering institutional context in analysing the HTA function within health systems
Original languageEnglish
Pages (from-to)162-181
Number of pages20
JournalHealth Economics, Policy and Law
Volume14
Issue number2
Early online date26 Mar 2018
DOIs
Publication statusPublished - 30 Apr 2019

Fingerprint

Biomedical Technology Assessment
Hungary
Eastern Europe
Aptitude
Private Sector
Power (Psychology)
Public Sector
Legislation
Decision Making
Organizations
Interviews
Health

Cite this

When health technology assessment is confidential and experts have no power: the case of Hungary. / Csanádi, Marcell; Löblová, Olga; Ozieranski, Piotr; Harsányi, Andras; Kalo, Zoltan; McKee, Martin; King, Lawrence.

In: Health Economics, Policy and Law, Vol. 14, No. 2, 30.04.2019, p. 162-181.

Research output: Contribution to journalArticle

Csanádi, Marcell ; Löblová, Olga ; Ozieranski, Piotr ; Harsányi, Andras ; Kalo, Zoltan ; McKee, Martin ; King, Lawrence. / When health technology assessment is confidential and experts have no power: the case of Hungary. In: Health Economics, Policy and Law. 2019 ; Vol. 14, No. 2. pp. 162-181.
@article{b7888c3b7cfe4260a9804b6fd1084644,
title = "When health technology assessment is confidential and experts have no power: the case of Hungary",
abstract = "Health technology assessment (HTA) is not simply a mechanistic technical exercise as it takes place within a specific institutional context. Yet, we know little about how this context influences the operation of HTA and its ability to influence policy and practice. We seek to demonstrate the importance of considering institutional context, using a case study of Hungary, a country that has pioneered HTA in Central and Eastern Europe. We conducted 26 in-depth, semi-structured interviews with public and private sector stakeholders. We found that while the HTA Department, the Hungarian HTA organisation, fulfilled its formal role envisaged in the legislation, its potential for supporting evidence-based decision-making was not fully realised given the low levels of transparency and stakeholder engagement. Further, the Department’s practical influence throughout the reimbursement process was perceived as being constrained by the payer and policymakers, as well as its own limited organisational capacity. There was also scepticism as to whether the current operational form of the HTA process delivered “good value for money”. Nevertheless, it still had a positive impact on the development of a broader institutional HTA infrastructure in Hungary. Our findings highlight the importance of considering institutional context in analysing the HTA function within health systems",
author = "Marcell Csan{\'a}di and Olga L{\"o}blov{\'a} and Piotr Ozieranski and Andras Hars{\'a}nyi and Zoltan Kalo and Martin McKee and Lawrence King",
year = "2019",
month = "4",
day = "30",
doi = "10.1017/S1744133118000051",
language = "English",
volume = "14",
pages = "162--181",
journal = "Health Economics, Policy and Law",
issn = "1744-1331",
publisher = "Cambridge University Press",
number = "2",

}

TY - JOUR

T1 - When health technology assessment is confidential and experts have no power: the case of Hungary

AU - Csanádi, Marcell

AU - Löblová, Olga

AU - Ozieranski, Piotr

AU - Harsányi, Andras

AU - Kalo, Zoltan

AU - McKee, Martin

AU - King, Lawrence

PY - 2019/4/30

Y1 - 2019/4/30

N2 - Health technology assessment (HTA) is not simply a mechanistic technical exercise as it takes place within a specific institutional context. Yet, we know little about how this context influences the operation of HTA and its ability to influence policy and practice. We seek to demonstrate the importance of considering institutional context, using a case study of Hungary, a country that has pioneered HTA in Central and Eastern Europe. We conducted 26 in-depth, semi-structured interviews with public and private sector stakeholders. We found that while the HTA Department, the Hungarian HTA organisation, fulfilled its formal role envisaged in the legislation, its potential for supporting evidence-based decision-making was not fully realised given the low levels of transparency and stakeholder engagement. Further, the Department’s practical influence throughout the reimbursement process was perceived as being constrained by the payer and policymakers, as well as its own limited organisational capacity. There was also scepticism as to whether the current operational form of the HTA process delivered “good value for money”. Nevertheless, it still had a positive impact on the development of a broader institutional HTA infrastructure in Hungary. Our findings highlight the importance of considering institutional context in analysing the HTA function within health systems

AB - Health technology assessment (HTA) is not simply a mechanistic technical exercise as it takes place within a specific institutional context. Yet, we know little about how this context influences the operation of HTA and its ability to influence policy and practice. We seek to demonstrate the importance of considering institutional context, using a case study of Hungary, a country that has pioneered HTA in Central and Eastern Europe. We conducted 26 in-depth, semi-structured interviews with public and private sector stakeholders. We found that while the HTA Department, the Hungarian HTA organisation, fulfilled its formal role envisaged in the legislation, its potential for supporting evidence-based decision-making was not fully realised given the low levels of transparency and stakeholder engagement. Further, the Department’s practical influence throughout the reimbursement process was perceived as being constrained by the payer and policymakers, as well as its own limited organisational capacity. There was also scepticism as to whether the current operational form of the HTA process delivered “good value for money”. Nevertheless, it still had a positive impact on the development of a broader institutional HTA infrastructure in Hungary. Our findings highlight the importance of considering institutional context in analysing the HTA function within health systems

U2 - 10.1017/S1744133118000051

DO - 10.1017/S1744133118000051

M3 - Article

VL - 14

SP - 162

EP - 181

JO - Health Economics, Policy and Law

JF - Health Economics, Policy and Law

SN - 1744-1331

IS - 2

ER -