Hostname: page-component-586b7cd67f-gb8f7 Total loading time: 0 Render date: 2024-11-28T10:34:32.323Z Has data issue: false hasContentIssue false
  • English
  • Français

Who’s afraid of institutionalizing health technology assessment (HTA)?: Interests and policy positions on HTA in the Czech Republic

Published online by Cambridge University Press:  07 November 2017

Olga Löblová
Olga Löblová*
Affiliation:
Visiting Professor, School of Public Policy, Central European University, Budapest, Hungary
*
*Correspondence to: Dr Olga Löblová, Research Associate, Department of Sociology, University of Cambridge, Free School Lane, Cambridge CB2 3QA, United Kingdom. Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

This article identifies the interests and policy positions of key health policy stakeholders regarding the creation of a health technology assessment (HTA) agency in the Czech Republic, and what considerations influenced them. Vested interests have been suggested as a factor mitigating the diffusion of HTA bodies internationally. The Czech Republic recently considered and discarded establishing an HTA agency, making it a good case for studying actors’ policy positions throughout the policy debates. Findings are based on in-depth, semi-structured expert and elite interviews with 34 key Czech health policy actors, supported by document analysis and extensive triangulation. Findings show that the HTA epistemic community of ‘aspiring agents’ was the only actor strongly in favor of an HTA body. Payers and the medical device and diagnostics industry were against it; patients and clinicians had no clear preferences. Original decision-makers were in favor but a new minister of health opted for a simpler policy alternative to solve his need for expertise. Existing institutions, policy alternatives and the institutional design of a future HTA body influence domestic actors’ preferences for or against an HTA agency. Domestic and international proponents of HTA should give serious thought to their concerns when advocating for HTA bodies.

Type
Articles
Information
Health Economics, Policy and Law , Volume 13 , Issue 2 , April 2018 , pp. 137 - 161
Check for updates
Copyright
© Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Adolph, C. (2013), Bankers, Bureaucrats, and Central Bank Politics, Cambridge: Cambridge University Press.Google Scholar
Alföldi Šperkerová, M. (2014), ‘Vyspělý svět počítá cenu života’ (The developed world is counting the price of life). Lidové Noviny, 15 May, page 19.Google Scholar
Allen, N., Pichler, F., Wang, T., Patel, S. and Salek, S. (2013), ‘Development of archetypes for Non-ranking classification and comparison of European national health technology assessment systems’, Health Policy (Amsterdam, Netherlands), 113(3): 305–312.Google Scholar
Bache, I. and Taylor, A. (2003), ‘The politics of policy resistance: reconstructing higher education in Kosovo’, Journal of Public Policy, 23(3): 279–300.CrossRefGoogle Scholar
Banta, D. (2003), ‘The development of health technology assessment’, Health Policy, 63: 121–132.Google Scholar
Barron, A. J. G., Klinger, C., Shah, S. M. B. and Wright, J. S. F. (2015), ‘A regulatory governance perspective on health technology assessment (HTA) in France: the contextual mediation of common functional pressures’, Health Policy (Amsterdam, Netherlands), 119(2): 137–146.Google Scholar
Battista, R. N. and Hodge, M. J. (2009), ‘The “natural history” of health technology assessment’, International Journal of Technology Assessment in Health Care, 25(S1): 281.CrossRefGoogle Scholar
Bendor, J., Glazer, A. and Hammond, T. (2001), ‘Theories of delegation’, Annual Review of Political Science, 4(1): 235.CrossRefGoogle Scholar
Benson, D. and Jordan, A. (2011), ‘What have we learned from policy transfer research? Dolowitz and Marsh revisited’, Political Studies Review, 9(3): 366–378.CrossRefGoogle Scholar
Berry, J. M. (2002), ‘Validity and reliability issues in elite interviewing’, Political Science and Politics, 35(4): 679–682.Google Scholar
Böhm, K., Landwehr, C. and Steiner, N. (2014), ‘What explains “generosity” in the public financing of high-tech drugs? An empirical investigation of 25 OECD countries and 11 controversial drugs’, Journal of European Social Policy, 24(1): 39–55.Google Scholar
Čabanová, A. (2014), ‘Přísně tajné přístroje [Top Secret MD&Ds]’. EURO, 22 September, Retrieved from http://euro.e15.cz/archiv/prisne-tajne-pristroje-1120505 [12 April 2015].Google Scholar
Capoccia, G. and Kelemen, R. D. (2007), ‘The study of critical junctures: theory, narrative, and counterfactuals in historical institutionalism’, World Politics, 59(3): 341–369.Google Scholar
CTK (2014), ‘VZP ends cooperation with proton center’. Prague Post, 20 November, Retrieved from http://praguepost.com/czech-news/42775-vzp-ends-cooperation-with-proton-center [7 November 2015].Google Scholar
Culpepper, P. D. (2010), Quiet Politics and Business Power: Corporate Control in Europe and Japan, Cambridge: Cambridge University Press.CrossRefGoogle Scholar
Danko, D. (2014), ‘Health technology assessment in middle-income countries: recommendations for a balanced assessment system’, Journal of Market Access & Health Policy, 1: 1–10.Google Scholar
Davies, P. H. J. (2001), ‘Spies as informants: triangulation and the interpretation of elite interview data in the study of the intelligence and security services’, Politics, 21(1): 73–80.Google Scholar
Dexter, L. A. (2006), Elite and Specialized Interviewing, Colchester: ECPR Press.Google Scholar
Directive 2011/24/EU (2011), ‘Directive 2011/24/EU of the European Parliament and of the Council of 9 March 2011 on the Application of Patients’ Rights in Cross-Border Healthcare’, Retrieved from http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2011:088:0045:0065:EN:PDF [3 February 2016].Google Scholar
Downs, A. (1967), Inside Bureaucracy, Prospect Heights III: Waveland Pr Inc.CrossRefGoogle Scholar
Dunleavy, P. (1991), Democracy, Bureaucracy and Public Choice, New York: Routledge.Google Scholar
Dunlop, C. (2000), ‘Epistemic communities: a reply to Toke’, Politics, 20(3): 137–144.Google Scholar
EUnetHTA (2012), ‘HTA definition’. EUnetHTA Website, Retrieved from http://www.eunethta.eu/Public/About_EUnetHTA/HTA/[September 18] [3 February 2015].Google Scholar
European Commission (2013), ‘Commission implementing decision of 26 June 2013 providing the rules for the establishment, management and transparent functioning of the network of national authorities or bodies responsible for health technology assessment’, Retrieved from http://ec.europa.eu/health/technology_assessment/docs/impl_dec_hta_network_en.pdf [27 February 2016].Google Scholar
European Commission Health and Consumers Directorate-General (2013), ‘Multiannual Work Programme 2014-2015 Adopted at the 1st HTA Network Meeting, 16 October 2013’. Brussels.Google Scholar
Ferrario, A. and Kanavos, P. (2015), ‘Dealing with uncertainty and high prices of new medicines: a comparative analysis of the use of managed entry agreements in Belgium, England, the Netherlands and Sweden’, Social Science and Medicine, 124: 39–47.Google Scholar
Ferrario, A. et al. (2017), “The implementation of managed entry agreements in Central and Eastern Europe: findings and implications”, PharmacoEconomics https://doi.org/10.1007/s40273-017-0559-4.Google Scholar
Finta, H., Kelemen, L. and Ács, V. (2013), ‘Public health and management the need and importance of implementing health technology assessment’, Acta Medica Transilvanica, 2(1): 169–171.Google Scholar
Garrido, M. V., Kristensen, F. B., Nielsen, C. P. and Busse, R. (2008), Health Technology Policy-Making in Europe: Current Status, Challenges and Potential, Copenhagen: World Health Organization, on behalf of the European Observatory on Health Systems and Policies.Google Scholar
Gibis, B., Artiles, J., Corabian, P., Meiesaar, K., Koppel, A., Jacobs, P., Serrano, P. and Menon, D. (2001), ‘Application of strengths, weaknesses, opportunities and threats analysis in the development of a health technology assessment program’, Health Policy (Amsterdam, Netherlands), 58(1): 27–35.Google Scholar
Gilardi, F. (2008), Delegation in the Regulatory State: Independent Regulatory Agencies in Western Europe, Bodmin: Edward Elgar Publication.Google Scholar
Goddard, M., Hauck, K. and Smith, P. C. (2006), ‘Priority setting in health – a political economy perspective’, Health Economics, Policy, and Law, 1(Pt 1): 79–90.Google Scholar
Guest, G., Bunce, A. and Johnson, L. (2006), ‘How many interviews are enough?: An experiment with data saturation and variability’, Field Methods, 18(1): 59–82.Google Scholar
Gulácsi, L., Rotar, A. M., Niewada, M., Löblová, O., Rencz, F., Petrova, G., Boncz, I. and Klazinga, N. S. (2014), ‘Health technology assessment in Poland, the Czech Republic, Hungary, Romania and Bulgaria’, The European Journal of Health Economics, 15(Supplement 1): S13–S25.Google Scholar
Haas, P. M. (1992), ‘Introduction: epistemic communities and international policy coordination’, International Organization, 46(1): 1–35.Google Scholar
Ham, C. and Coulter, A. (2001), ‘Explicit and implicit rationing: taking responsibility and avoiding blame for health care choices’, Journal of Health Services Research & Policy, 6(3): 163–169.Google Scholar
Hartz, S. and John, J. (2009), ‘Public health policy decisions on medical innovations: what role can early economic evaluation play?’, Health Policy, 89(2): 184–192.Google Scholar
Hood, C. (2007), ‘What happens when transparency meets blame-avoidance?’, Public Management Review, 9(2): 191–210.Google Scholar
Hutton, J., McGrath, C., Frybourg, J.-M., Tremblay, M., Bramley-Harker, E. and 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.Google Scholar
iHETA (2013), ‘HTA v České Republice: Perspektivy a zahraniční inspirace (HTA in the Czech Republic: Perspectives and International Inspiration)’, Sborník Příspěvků Z Konference HTA: Vybudování Odborné Kapacity pro Health Technology Assessment v České Republice Po Vzoru Švýcarska (Conference Proceedings: Health Technology Assessment Capacity Building in the Czech Republic Following the Swiss Example), 17 April 2013, Hotel Park Inn, Praha, Česká Republika.Google Scholar
INAHTA (2016), ‘Welcome to INAHTA’. International Network of Agencies for Health Technology Assessment, Retrieved from http://www.inahta.org/ [3 February 2015].Google Scholar
Jones, K., Baggott, R. and Allsop, J. (2004), ‘Influencing the national policy process: the role of health consumer groups’, Health Expectations: An International Journal of Public Participation in Health Care and Health Policy, 7(1): 18–28.CrossRefGoogle ScholarPubMed
Kaló, Z., Gheorghe, A., Huic, M., Csanádi, M. and Kristensen, F. B. (2016), ‘HTA implementation roadmap in Central and Eastern European countries’, Health Economics, 25: 179–192.Google Scholar
Kaminska, M. E. (2013), ‘The missing dimension: a comparative analysis of healthcare governance in Central and Eastern Europe’, Journal of Comparative Policy Analysis: Research and Practice, 15(1): 68–86.Google Scholar
Kanavos, P. and Ferrario, A. (2013), ‘Managed entry agreements for pharmaceuticals: the European experience,” 1–150. Retrieved from http://eprints.lse.ac.uk/50513/1/__Libfile_repository_Content_Ferrario,%20A_Ferrario_Managed_%20entry_%20agreements_2013_Ferrario_Managed_%20entry_%20agreements_2013.pdf [3 October 2017].Google Scholar
Kang, M. and Reich, M. R. (2014), ‘Between credit claiming and blame avoidance: the changing politics of priority-setting for Korea’s National Health Insurance System’, Health Policy (Amsterdam, Netherlands), 115(1): 9–17.Google Scholar
Kristensen, F. B. (2012), ‘Development of European HTA: from vision to EUnetHTA’, Michael, 9: 147–156.Google Scholar
Landwehr, C. and Boehm, K. (2011), ‘Delegation and institutional design in health-care rationing’, Governance, 24(4): 665–688.Google Scholar
Lavín, C. P., Alaniz, R. and Espinoza, M. (2017), ‘Visions of stakeholders about instutionalization of health technology assessment in Chile: a qualitative study’, International Journal of Technology Assessment in Health Care, 33(2): 1–4.Google Scholar
Littig, B. (2009), ‘Interviewing the elite – interviewing experts: is there a difference?’, in A. Bogner, B. Littig, and W. Menz (eds), Interviewing Experts, e-book: Springer, 98–113.Google Scholar
Löblová, O. (2016), ‘Three Worlds of Health Technology Assessment: explaining patterns of diffusion of HTA agencies in Europe’, Health Economics, Policy and Law, 11(3): 253–273.Google Scholar
Löblová, O. (2017), ‘When Epistemic Communities Fail: Exploring the Mechanism of Policy Influence’, Policy Studies Journal, 10.1111/psj.12213.Google Scholar
Lohmann, S. (2003), ‘Representative government and special interest politics (we have met the enemy and he is us)’, Journal of Theoretical Politics, 15(3): 299–319.Google Scholar
Lopert, R., Ruiz, F. and Chalkidou, K. (2013), ‘Applying rapid “de-facto” HTA in resource-limited settings: experience from Romania’, Health Policy (Amsterdam, Netherlands), 112(3): 202–208.Google Scholar
Marsh, D. and Sharman, J. C. (2009), ‘Policy diffusion and policy transfer’, Policy Studies, 30(3): 269–288.Google Scholar
McNaughton Nicholls, C., Mills, L. and Kotecha, M. (2014), ‘Observation’, in R. O. J. Ritchie, J. Lewis and C. McNaughton Nicholls (eds), Qualitative Research Practice: A Guide for Social Science Students and Researchers, London: Sage, 243–268.Google Scholar
Meseguer, C. (2005), ‘Policy learning, policy diffusion, and the making of a new order’, The Annals of the American Academy of Political and Social Science, 598(1): 67–82.Google Scholar
Ministerstvo zdravotnictví ČR (2014), ‘Přístrojová Komise – Úvodní Slovo’ (MD&D Committee – Introduction), Retrieved from http://www.mzcr.cz/obsah/pristrojova-komise_3121_3.html [12 April 2015].Google Scholar
Ministry of Health of the Czech Republic (2015), ‘122-2015 Odůvodnění Stanoviska Přístrojové Komise (Explanation of the Recommendation of the MD&D Committee)’, http://www.mzcr.cz/dokumenty/122-2015-oduvodneni-stanoviska-pristrojove-komise_10935_3264_1.html [12 April 2015].Google Scholar
Moe, T. M. (1990), ‘Political institutions: the neglected side of the story’, Journal of Law, Economics, and Organization, 6: 213–253.Google Scholar
Moharra, M., Espallargues, M., Kubesch, N., Estrada, M.-D., Parada, A., Vondeling, H., Scalzo, A. L., Cristofides, S., Turk, E. and Raab, M. (2009), ‘Systems to support health technology assessment (HTA) in member states of the European Union with limited institutionalization of HTA’, International Journal of Technology Assessment in Health Care, 25(Supplement 2): 75–83.Google Scholar
Moran, V. and Fidler, A. (2010), ‘Health technology assessment in Europe: communicating and applying lessons learned from high-income countries to middle-income countries’, Journal of Management & Marketing in Healthcare, 3(2): 141–149.Google Scholar
Morris, Z. S. (2009), ‘The truth about interviewing elites’, Politics, 29(3): 209–217.Google Scholar
Müller, V. (2012), ‘VZP V SOUVISLOSTECH: Nový vítr do plachet, nebo jen vítr ve vedení? (VZP in Context: Fresh Breath, or Just Purges in Top Management?)’. ČT24, 26 November, Retrieved from http://www.ceskatelevize.cz/porady/10101491767-studio-ct24/212411058311126/video/231764 [1 February 2016].Google Scholar
Mykhalovskiy, E. and Weir, L. (2004), ‘The problem of evidence-based medicine: directions for social science’, Social Science and Medicine, 59(5): 1059–1069.Google Scholar
Nadační fond proti korupci, and S.r.o V97 (2012), ‘Zdravotnictví v České Republice a jeho privatizace (Health Care in the Czech Republic and Its Privatization)’, Retrieved from http://www.nfpk.cz/_userfiles/soubory/granty/zdravotnictvi_nfpk_v97_final.pdf [3 February 2016].Google Scholar
Niskanen, W. A. (1971), Bureaucracy & Representative Government, London: Transaction Publishers.Google Scholar
Nohl, R. and Rodriguez, V. (2015), ‘Ostravská nemocnice předražila za němečka nákup o 65 milionů, tvrdí policie. Část peněz zmrazila (Hospital in Ostrava Overpriced Purchasing by 65 Millions during Nemecek’s Directorship, Police Says. Part of Money Now Blocked)’. Aktuálně.cz, 22 October, Retrieved from http://zpravy.aktualne.cz/domaci/cyberknife-ostravska-nemocnice-predrazila-o-65-milionu-tvrdi/r~04a6ce6e78a411e5b286002590604f2e/ [1 February 2016].Google Scholar
Oortwijn, W., Mathijssen, J. and Banta, D. (2010), ‘The role of health technology assessment on pharmaceutical reimbursement in selected middle-income countries’, Health Policy (Amsterdam, Netherlands), 95(2–3): 174–184.Google Scholar
Ozieranski, P., McKee, M. and King, L. (2012a), ‘Pharmaceutical lobbying under postcommunism: universal or country-specific methods of securing state drug reimbursement in Poland?”’, Health Economics, Policy, and Law, 7(2): 175–195.Google Scholar
Ozieranski, P., McKee, M. and King, L. (2012b), ‘The politics of health technology assessment in Poland’, Health Policy (Amsterdam, Netherlands), 108 (2–3): 178–193.Google Scholar
Palát, M. (2011), ‘Dozrál čas pro zavedení HTA do české zdravotnické praxe (The Time Is Ripe for Introducing HTA into Czech Health Care Practice)’. MEDICAL TRIBUNE CZ, 9 April, Retrieved from http://www.tribune.cz/clanek/22131-dozral-cas-pro-zavedeni-hta-do-ceske-zdravotnicke-praxe [3 February 2013].Google Scholar
Palát, M. (2013), ‘Pohled průmyslu na HTA zdravotnických prostředků (The View of the Industry on HTA of Medical Devices and Diagnostics)’. PharmAround Workshop HTA 16 November 2013, Brno, Retrieved from http://czechhta.cz/wp-content/uploads/2014/04/Palat.pdf [2 October 2017].Google Scholar
Panteli, D., Eckhardt, H., Nolting, A., Busse, R. and Kulig, M. (2015), ‘From market access to patient access: overview of evidence-based approaches for the reimbursement and pricing of pharmaceuticals in 36 European countries’, Health Research Policy and Systems, 13(1): 39.Google Scholar
Petrášová, L. (2012), ‘Heger má plán, jak zarazit nemocnicím kšefty s přístroji (Heger Has a Plan How to Cut Hospitals from Shady Deals with Medical Devices and Diagnostics)’. Mladá Fronta DNES, 29 September, page 5.Google Scholar
Posner, R. A. (1974), ‘Theories of Economic Regulation’. NBER Working Paper Series No. 41. Retrieved from http://www.nber.org/papers/w0041 [2 October 2017].Google Scholar
Saarni, S. I. (2004), ‘Evidence based medicine guidelines: a solution to rationing or politics disguised as science?’, Journal of Medical Ethics, 30(2): 171–175.CrossRefGoogle ScholarPubMed
Schreier, M. (2014), ‘Qualitative content analysis’, in U. Flick (ed.), The SAGE Handbook of Qualitative Data Analysis, Thousand Oaks, CA: SAGE, 170–183.CrossRefGoogle Scholar
Sebenius, J. K. (1992), ‘Challenging conventional explanations of international cooperation: negotiation analysis and the case of epistemic communities’, International Organization, 46(1): 323.Google Scholar
Shah, S. M. B., Barron, A., Klinger, C. and Wright, J. S. F. (2014), ‘A regulatory governance perspective on health technology assessment (HTA) in Sweden’, Health Policy (Amsterdam, Netherlands), 116(1): 27–36.Google Scholar
Sorenson, C. and Chalkidou, K. (2012), ‘Reflections on the evolution of health technology assessment in Europe’, Health Economics, Policy, and Law, 7(1): 25–45.Google Scholar
Stigler, G. J. (1971), ‘The economic theory of regulation’, The Bell Journal of Economics and Management Science, 2(1): 3–21.Google Scholar
Sweet, A. S. and Thatcher, M. (2002), ‘Theory and practice of delegation to non-majoritarian institutions’, West European Politics, 2012: 37–41.Google Scholar
Tansey, O. (2007), ‘Process tracing and elite interviewing: a case for non-probability sampling’, PS: Political Science and Politics, 40(4): 765–772.Google Scholar
Thatcher, M. and Sweet, A. S. (2002), ‘Theory and practice of delegation to non-majoritarian institutions’, West European Politics, 25(1): 1–22.Google Scholar
VASPVT and LBI (2015), ‘HTA-strategy for Lithuania’, Retrieved from http://eprints.hta.lbg.ac.at/1064/1/DSD_90a.pdf [3 February 2016].Google Scholar
Velasco Garrido, M., Gerhardus, A., Røttingen, J.-A. and Busse, R. (2010), ‘Developing health technology assessment to address health care system needs’, Health Policy (Amsterdam, Netherlands), 94(3): 196–202.Google Scholar
Vepřek, P. (2011), ‘Hodnocení zdravotnických technologií v ČR (Evaluation of Health Technology in the Czech Republic)’. n/a.Google Scholar
Vepřek, P. (2013a), ‘HTA – strategie zavádění a legislativního kotvení (HTA – Strategy for Introduction and Legislative Embedding)’. March, n/a.Google Scholar
Vepřek, P. (2013b), ‘Zavádění HTA v České Republice (Introducing HTA in the Czech Republic)’, April, Retrieved from http://www.iheta.org/ext/files/21/HTA_v_%25C4%258CR-17-04-2013-Vep%25C5%2599ek.pdf [3 February 2016].Google Scholar
Wendt, C., Agartan, T. I. and Kaminska, M. E. (2013), ‘Social health insurance without corporate actors: changes in self-regulation in Germany, Poland and Turkey’, Social Science and Medicine, 86: 88–95.Google Scholar
Weyland, K. (2005), ‘Theories of policy diffusion lessons from Latin American pension reform’, World Politics, 57(2): 262–295.Google Scholar
Wild, C., Patera, N., Stricka, M. and Karnickas, L. (2015), Background Analysis for National HTA Strategy for Lithuania Focus on Medical Devices, Vienna: Ludwig Boltzmann Institute.Google Scholar
zdravi.e15.cz (2014), ‘Ministerstvo chce zefektivnit využívání drahé zdravotnické techniky (The Ministry Wants to Make the Use of Expensive Medical Technology More Efficient)’, zdravi.e15.cz, 11 April, Retrieved from http://zdravi.e15.cz/denni-zpravy/z-domova/ministerstvo-chce-zefektivnit-vyuzivani-drahe-zdravotnicke-techniky-475024 [3 February 2016].Google Scholar