London School of Economics and Political Science, Houghton Street, London WC2A 2AE, United Kingdom.
Health Policy. 2013 Mar;109(3):270-80. doi: 10.1016/j.healthpol.2013.01.004. Epub 2013 Feb 4.
There are no automatic links between the functional advantages and pressures associated with delegation to independent agencies for Health Technology Assessment (HTA) and their emergence in national regulatory spaces. We argue that the rise of these organizations is mediated by contextual factors, which must be explained. Accordingly, we analyze the German 'regulatory space' for health policy decision-making, identifying contextual factors relevant to the adoption of the Efficiency Frontier approach. Based on qualitative interviews with key stakeholders, we argue that the development of the Efficiency Frontier can be associated with cultural reluctance to frame healthcare prioritization decisions around cost based valuations of human health and related doubts about the validity of metrics for human health gain. Based on this finding, we conclude that the delegation of authority to independent HTA agencies follows a broadly evolutionary pattern, in which contextual factors allow for significant variation in institutional and methodological responses to the functional pressures and advantages leading to their establishment.
功能优势与将卫生技术评估（HTA）委托给独立机构相关的压力之间没有自动联系，它们也不会自动出现在国家监管领域中。我们认为，这些组织的出现是由各种情境因素所介导的，而这些因素必须加以解释。因此，我们分析了德国卫生政策决策的“监管空间”，确定了与采用效率前沿方法相关的情境因素。通过对主要利益攸关方的定性访谈，我们认为效率前沿的发展可能与文化上不愿意围绕基于成本的人类健康价值评估来制定医疗保健优先决策有关，也与对人类健康收益衡量标准的有效性相关的疑虑有关。基于这一发现，我们得出结论，将权力委托给独立的 HTA 机构遵循着一种广泛的演进模式，在这种模式下，情境因素允许在制度和方法上对导致其建立的功能压力和优势做出重大的变化。
