DÜŞÜK VE ORTA GELİRLİ ÜLKELERDE SAĞLIK TEKNOLOJİLERİNİN DEĞERLENDİRİLMESİNDE DENGELİ PERSPEKTİF İHTİYACI

Yıl 2021, Cilt: 24 Sayı: 4, 885 - 902, 27.12.2021

Songül Çınaroğlu

Öz

Sağlık teknolojilerinin değerlendirilmesi (STD) sağlık sistemlerinin iyileştirilmesinde faydalanılan önemli tekniklerden birisidir. Sağlık sistemlerinin geliştirilmesi için Avrupa STD ajansı gibi uluslararası kuruluşlar özellikle düşük ve orta gelirli ülkeler (DOGÜ) için yol haritası belirleme ihtiyacına dikkat çekmektedir. STD sağlık politikası analistleri için çok boyutlu bir araştırma alanıdır. Sağlık teknolojileri tüm dünyada benzer zorluklarla karşı karşıya kalmaktadır. DOGÜ’de sağlık sistemlerinin iyileştirilmesi için sağlık teknolojilerinin doğru değerlendirilmesi önem arz etmektedir. Bu çabaların daha organize bir hale getirilebilmesi için bu ülkelerde dengeli bir yaklaşıma ihtiyaç vardır. Bu nedenle bu çalışmada DOGÜ’de sağlık teknolojilerinin değerlendirilmesinde yol haritası belirlemeye duyulan ihtiyaç ve dengeli sistemlerin üzerinde durulması amaçlanmıştır. Bu amaçla bu çalışmada DOGÜ’lerde sağlık ekonomisinin genel çerçevesi, DOGÜ’lerde dördüncü boşluk olarak STD, DOGÜ’lerde STD için yol haritası ve dengeli sistem ihtiyacı ve DOGÜ’lerde STD konusundaki çalışmalarda dengeli puan cetvelinin adaptasyonu konularındaki literatür bilgisi sentezlenmiştir. Çalışmada DOGÜ’de STD politikaları derinlemesine incelenmiş ve dengeli bakış açısına duyulan gereksinim vurgulanmıştır. Sonuç olarak, sağlık sistemindeki farklılıklar ve ülkeler arasında insan kaynakları ve finansal kaynaklar açısından görülen politika ve farklılıklar nedeniyle tüm DOGÜ için aynı STD yaklaşımının uygulanmasının mümkün olmadığı söylenebilmektedir. Sağlıkta politika yapıcılara, DOGÜ’de STD’nin geliştirilebilmesi için, kılavuzlardan ve dengeli yaklaşımlardan faydalanmanın önemi tavsiye edilmiştir.

Anahtar Kelimeler

Sağlık teknolojilerinin değerlendirilmesi, düşük gelirli ülkeler, orta gelirli ülkeler, sağlık teknolojileri, sağlık ekonomisi

NEED FOR BALANCED PERSPECTIVE IN HEALTH TECHNOLOGY ASSESSMENT FOR LOW- AND MIDDLE-INCOME COUNTRIES

Öz

Health technology assessment (HTA) is an important technique used for improvement of health care systems. For improving health care systems, international organizations, such as the European HTA agency, emphasizes the need for developing roadmaps for HTA, particularly for low- and middle-income countries (LMICs). HTA is a multidisciplinary research tool for health care policy analysts. Health care technologies face similar challenges worldwide. It is important to properly assess health technologies for improving health systems in LMICs. To conduct these assessments in a more coordinated manner, there is a need for a balanced perspective for these countries. To fill this void this study aimed to describe the need for roadmaps and balanced systems for assessing health care technologies in LMICs. With this regard, this study examines and synthesis the literature surrounding general picture of health economics in LMICs, HTA as a fourth hurdle in LMICs, need for roadmap and balanced systems for HTA in LMICs and adaptation of balanced scorecard to HTA studies in LMICs. In the study, HTA policies in LMICs were examined in depth and the need for a balanced perspective was emphasized. As a result of this review, it was demonstrated that it is difficult to implement the same HTA approaches in all LMICs because of differences in health care systems and policies and differences in both human and financial resources between these countries. We highlighted the importance of using guidelines and recommend using balanced systems in HTAs for health policy makers to improve HTAs in LMICs.

Anahtar Kelimeler

Health technology assessment, low-income countries, middle-income countries, health technologies, health economics

Kaynakça

• Atikeler, K., Leufkens, H. G. M., & Goettsch, W. (2020). Access to medicines in Turkey: Evaluation of the process of medicines brought from abroad. International Journal of Health Technology Assessment in Health Care, 36(6), 585-591.
• Atkins, S., Marsden, S., Diwan, V., Zwarenstein, M., & for the ARCADE Consortium. (2016). North–south collaboration and capacity development in global health research in low- and middle-income countries – the ARCADE projects. Global Health Action, 9(1), 30524.
• Atkinson, H. (2006). Strategy implementation: A role for the balanced scorecard? Management Decision, 44(10), 1441-1460.
• Attieh, R., & Gagnon, M. P. (2012). Implementation of local/hospital-based health technology assessment initiatives in low- and middle-income countries. International Journal of Technology Assessment in Health Care, 28(4), 445-451.
• Babigumira, J. B., Jenny, A. M., Bartlein, R., Stergachis, A., & Garrison, L. P. (2016). Health technology assessment in low‐ and middle‐income countries: A landscape assessment. Journal of Pharmaceutical Health Services Research, 7(1), 37-42.
• Behrouzi, F., & Ma’aram, A. (2019). Identification and ranking of specific balanced scorecard performance measures for hospitals: A case study of private hospitals in the Klang Valley area, Malaysia. International Journal of Health Planning and Management, 34(4), 1364-1376.
• Bishai, D. M., Cohen, R., Alfonso, Y. N., Adam, T. , Kuruvilla, S., & Schweitzer, J. (2016). Factors contributing to maternal and child mortality reductions in 146 low- and middle-income countries between 1990 and 2010. PLoS One, 11(1), e0144908.
• Blendon, R. J., Schoen, C., DesRoches, C. M., Osborn, R., Scoles, K. L., & Zapert, K. (2002). Inequalities in health care: A five country survey. Health Affairs (Millwood), 21(3), 182-191.
• Braithwaite, J., Mannion, R., Matsuyama, Y., Shekelle, P., Whittaker, S., & Al-Adawi (2017). Accomplishing reform: Successful case studies drawn from the health systems of 60 countries. International Journal for Quality in Health Care, 29(6), 880–886.
• Cleemput, I., Neyt, M., Thiry, N., Leat, C. D., & Leys, M. (2008). Threshold values for cost-effectiveness in health care. The Belgian Health Care Knowledge Center, Belgium.
• Cremieux, P. Y., Ouellette, P., & Pilon C. (1999). Health care spending as determinants of health outcomes. Health Economics, 8(7), 627-639.
• Danko, D. (2014). Health technology assessment in middle income countries: Recommendations for a balanced assessment system. Journal of Market Access & Health Policy, 2(1), 1-10.
• Danko, D., & Petrova, G. (2014). Health technology assessment in the Balkans: Opportunities for a balanced drug assessment system. Biotechnology & Biotechnological Equipment, 28(6), 1181-1189.
• Deidda, M., Geue, C., Kreif, N., Dundas, R., & McIntosh, E. (2019). A framework for conducting economic evaluations alongside natural experiments. Social Science & Medicine, 220, 353–361.
• Demirbas, A. R., Oner, N., Beyan, A., Sener, O., & Turgut, C. G. (2015). Health technology assessment practices in Turkey. Value in Health, 18(7), 575.
• Drummond, M., Neumann, P., Jönnson, B., & Luce, B. (2012). Can we reliably benchmark health technology assessment organizations? International Journal of Health Technology Assessment, 28(2), 1-7.
• Ekman, B. (2004). Community based health insurance in low income countries: A systematic review of the evidence. Health Policy and Planning, 19(5), 249-270.
• Ensor, T., & Cooper, S. (2004). Overcoming barriers to health service access: Influencing the demand side. Health Policy and Planning, 19(2), 69-79.
• Erlangga, D., Suhrcke, M., Ali, S., & Bloor, K. (2019). The impact of public health insurance on health care utilisation, financial protection and health status in low- and middle-income countries: A systematic review. PLoS ONE, 14(8), e0219731.
• Facey, K. (2006). Health technology assessment glossary. INAHTA Secretariat, Sweden.
• Figueroa, C.A., Harrison, R., Chauhan, A., & Meyer, L. (2019). Priorities and challenges for health leadership and workforce management globally: A rapid review. BMC Health Services Research, 19(1), 1-11.
• Fuchs, S., Olberg, B., Perleth, M., Busse, R., & Panteli, D. (2019). Testing a new taxonomic model for the assessment of medical devices: Is it plausible and applicable? Insights from HTA reports and interviews with HTA institutions in Europe. Health Policy, 123(2), 173-181.
• Garrido, M., Gerhardus, A., Rottingen, J. A., & Busse, R. (2010). Developing health technology assessment to address health care system needs. Health Policy, 94(3), 196-202.
• Gottret, P., & Schieber, G. (2006). Health financing revisited a practitioner’s guide. World Bank Publications.
• Grigoroudis, E., Orfanoudaki, E., & Zopounidis, C. (2012). Strategic performance measurement in a healthcare organisation: A multiple criteria approach based on balanced scorecard. Omega, 40(1), 104-119.
• Gurd, B., & Gao, T. (2008). Lives in the balance: an analysis of the balanced scorecard (BSC) in healthcare organizations. International Journal of Productivity and Performance Management, 57(1), 6-21.
• Hall, P. S. (2017). Real-world data for efficient health technology assessment. European Journal of Cancer, 79, 235-237.
• Hanson, K., Barasa, E., Honda, A., Panichkriangkrai, W., & Patcharanarumol, W. (2019). Strategic purchasing: The neglected health financing function for pursuing universal health coverage in low- and middle-ıncome countries. International Journal of Health Policy and Management, 8(8), 501–504.
• Hollingworth, S., Gyansa-Lutterodt, M., Dsane-Selby, L., Nonvignon, J., Lopert, R., Gad, M., ... & Chalkidou, K. (2020). Implementing health technology assessment in Ghana to support universal health coverage: Building relationships that focus on people, policy, and process. International Journal of Technology Assessment in Health Care, 36(1), 8-11.
• Homer, J. B., & Hirsch, G. B. (2005). System dynamics modeling for public health: Background and opportunities. American Journal of Public Health, 96(3), 452-458.
• Hosseinpoor, A. R., Bergen, N., Kunst, A., Harper, S., Guthold, R., Rekve, D., ... & Chatterji, S. (2012). Socioeconomic inequalities in risk factors for non communicable diseases in low-income and middle-income countries: Results from the World Health Survey. BMC Public Health, 12(1), 1-13.
• Houweling, T. A. J. & Kunst, A. E. (2010). Socio-economic inequalities in childhood mortality in low- and middle-income countries: a review of the international evidence. British Medical Bulletin, 93(1), 7-26.
• Hulstaert, F, Ruether, A., Demotes, J., & Melien, Ø. (2020). Closing the cycle of innovation in healthcare in Europe. International Journal of Technology Assessment in Health Care, 36(2), 75-79.
• Hutton, J., McGrath, C., Frybourg, J.M., Tremblay, M., Bramley-Harker, E., & Henshall, C. (2006). Framework for describing and classifying decision-making systems using technology assessment to determine the reimbursement of health technologies (fourth hurdle systems). International Journal of Technology Assessment in Health Care, 22(1), 10-18.
• John, D. (2019). HTA flourishing in Asia. International Journal of Health Technology Assessment in Health Care, 35, 411–412.
• Kalo, Z., Bodrogi, J., Boncz, I., Dozsa, C., Jona, G., Kövi, R., Pasztelyi, Z., & Sinkovits, B. (2013). Capacity building for HTA implementation in middle-income countries: The case of Hungary. Value in Health Regional Issues, 2, 264-266.
• Kaplan, R. S., & Norton, D. P. (1992). The balanced scorecard measures that drive performance. Harvard Business Review, 70(1), 70-79.
• Khan, S., Vandermorris, A., Shepherd, J., Begun, J. W., Lanham, H. J., Uhl-Bien, M., & Berta, W. (2018). Embracing uncertainty, managing complexity: Applying complexity thinking principles to transformation efforts in healthcare systems. BMC Health Services Research, 18(1), 1-8.
• Koon, A. D., Windmeyer, L., Bigdeli, M., Charles, J., Uneke, J., & Bennett, S. (2020). A scoping review of the uses and institutionalisation of knowledge for health policy in low- and middle-income countries. Health Research Policy and Systems, 18(7), 1-12.
• Kriza, C., Hanass-Hancock, J., Odame, E. A., Deghaye, N., Aman, R., Wahlster, P., Marin, M., Gebe, N., Akhwale, W., Wachsmuth, I., & Kolominsky-Rabas, P. L. (2014). A systematic review of health technology assessment tools in Sub-Saharan Africa: Methodological issues and implications. Health Research Policy and Systems, 12(66), 2-13.
• Kuchenbecker, R., & Polancyzk, C. A. (2012). Institutionalizing health technology assessment in Brazil: Challanges ahead. Value in Health Regional Issues, 1(2), 257-261.
• Kularatna, S., Whitty, J. A., Johnson, N. W., & Scuffham, P. A. (2013). Health state valuation in low and middle income countries: A systematic review of the literature. Value in Health, 16(6), 1091-1099.
• Mathes, T., Jacobs, E., Morfeld, J.C., & Pieper, D. (2013). Methods of international health technology assessment agencies for economic evaluations: A comparative analysis. BMC Health Service Research, 13(371), 1-10.
• McCoy, D., Chand, S., & Sridhar, D. (2009). Global health funding: How much, where it comes from and where it goes. Health Policy and Planning, 24(6), 407-417.
• Mills, A. (1998). The contract or not to contract? Issues for low and middle income countries. Health Policy and Planning, 13(1), 32-40.
• Mills, A. (2014). Health care systems in low- and middle- income countries. The New England Journal of Medicine, 370(6), 552-557. National Research Council (NRC) (2009). Science and decisions, advancing risk assessment, the national academies press. 500 Fifth Street, Washington.
• Niessen, L. W., Mohan, D., Akuoku, J. K., Mirelman, A. J., Ahmed, S., Koehlmoos, T. P., ... & Peters, D. H. (2018). Tackling socioeconomic inequalities and non-communicable diseases in low-income and middle-income countries under the sustainable development agenda. The Lancet, 391(10134), 2036-2046.
• O’Donnell, J. C., Pham, S. V., Pashos, C. L., Miller, D.W., & Smith, M. D. (2009). Health technology assessment: Lessons learned from around the world an overview. Value in Health, 12(2), 1-5.
• Oliveira, M. D., Mataloto, I. & Kanavos, P. (2019). Multi-criteria decision analysis for health technology assessment: Addressing methodological challenges to improve the state of the art. The European Journal of Health Economics, 20(6), 891–918.
• Oortwijn, W., Mathijssen, J., & Banta, D. (2010). The role of health technology assessment on pharmaceutical reimbursement in selected middle income countries. Health Policy, 95(2-3), 174-184.
• Osipenko, L. (2005). System dynamics in early health technology assessment (EHTA): Prenatal screening technology (eli-p complex) [Doctoral Dissertation]. Stevens Institute of Technology, Hoboken, US.
• Ozturk, K., Karadayı, B., & Şener, O. (2017). Stakeholders’ perceptions of health technology assessment in Turkey. International Journal of Technology Assessment in Health Care, 34(1), 1-8.
• Popkin, B. M. (1998). The nutrition transition and its health implications in lower-income countries. Public Health Nutrition, 1(1), 5-21.
• Rogowski, W. H., Hartz, S. C., & John, J. H. (2008). Clearing up the hazy road from bench to bedside: A framework for integrating the fourth hurdle into translational medicine. BMC Health Services Research, 8(194), 1-12.
• Schell, C. O., Reilly, M., Rosling, H., Peterson, S., & Ekstrom, A. M. (2006). Socioeconomic determinants of infant mortality: A worldwide study of 152 low-, middle-, and high-income countries. Scandinavian Journal of Public Health, 35(3), 288-297.
• Sorenson, C., Drummond, M., & Kavanos, P. (2008). Ensuring value for money in health care the role of health technology assessment in European Union. World Health Organization (WHO),
• European Observatory on Health Systems and Policies. Retrieved from http://www.euro.who.int/__data/assets/pdf_file/0011/98291/E91271.pdf. Accessed on 02.04.2015.
• Sparkes, S. P., Bump, J. B., & Reich, M. R. (2015). Political strategies for health reform in Turkey: Extending veto point theory. Health Systems & Reform, 1(4), 263-275.
• Street, J., Stafinski, T., Lopes, E., & Menon, D. (2020). Defining the role of the public in Health Technology Assessment (HTA) and HTA-informed decision-making processes. International Journal of Technology Assessment in Health Care, 36(2), 85-97.
• Sullivan, N. J., Mayo, K., Holmstrom, S., Matuszewski, K., & Szeinbach, S. (2006). Health decision-making and reimbursement processes. ISPOR The Official News & Technical Journal of the International Society for Pharmacoeconomics and Outcomes Research ISPOR. Retrieved from http://www.ispor.org/about-ispor.asp. Accessed on 02.04.2015.
• Taylor, R., & Taylor, R. (2009). What is health technology assessment. Retrieved from http://www.medicine.ox.ac.uk/bandolier/painres/download/whatis/What_is_health_tech.pdf. Accessed on 30.03.2015.
• Taylor, R. S., Drummond, M. F., Salkeld, G., & Sullivan, S. D. (2004). Inclusion of cost effectiveness in licensing requirements of new drugs: The fourth hurdle. BMJ, 329(7472), 972-975.
• The International Network of Agencies for Health Technology Assessment (INAHTA) (2020). What is Health Technology Assessment (HTA)? Retrieved from http://www.inahta.org/. Accessed on 02.03.2020.
• Torraco, R. J. (2005). Writing integrative literature review: Guideline and examples. Human Resource Development Review, 4(3), 356-368.
• Vella Bonanno, P., Bucsics, A., Simoens, S., Martin, A. P., Oortwijn, W., Gulbinovič, J., ... & Godman, B. (2019). Proposal for a regulation on health technology assessment in Europe–opinions of policy makers, payers and academics from the field of HTA. Expert Review of Pharmacoeconomics & Outcomes Research, 19(3), 251-261.
• Vural, I. E. (2017). Financialisation in health care: An analysis of private equity fund investments in Turkey. Social Science & Medicine, 187, 276-286.
• Wahlster, P., Scahill, S., Lu, C. Y., & Badar, Z. U. D. (2015). Barriers to access and use of the high cost medicines: A review. Health Policy and Technology, 4(3), 191-214.
• Wharam J. F., Fang, Z., Jamie, W., Christine, L., & Craig, E. (2019). Vulnerable and less vulnerable women in high-deductible health plans experienced delayed breast cancer care. Health Affairs (Millwood), 38(3), 408-415.
• World Bank (WB) (2020). Country and lending groups. Retrieved from https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups. Accessed on 30.03.2020.
• World Health Organization (WHO) (2015). How much should countries spend on health? Retrieved from http://www.who.int/health_financing/en/how_much_should_dp_03_2.pdf Accessed on 31.03.2020.
• Zelman, W. N., Pink, W. G., & Matthias, C. B. (2003). Using balanced scorecard in health care. Journal of Health Care Finance, 29(4), 1-16.