Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Landmark Center, 401 Park Drive Suite 401, Boston, MA, 02215, USA.
BMC Health Serv Res. 2020 Apr 25;20(1):351. doi: 10.1186/s12913-020-05152-2.
Public health care payer organizations face increasing pressures to make transparent and sustainable coverage decisions about ever more expensive prescription drugs, suggesting a need for public engagement in coverage decisions. However, little is known about countries' approaches to integrating public preferences in existing funding decisions. The aim of this study was to describe how Belgium and New Zealand used deliberative processes to engage the public and to identify lessons learned from these countries' approaches.
To describe two countries' deliberative processes, we first reviewed key country policy documents and then conducted semi-structured interviews with five leaders of the processes from Belgium and New Zealand. We assessed each country's rationales for and approaches to engaging the public in pharmaceutical coverage decisions and identified lessons learned. We used qualitative content analysis of the interviews to describe key themes and subthemes.
In both countries, the national public payer organization initiated and led the process of integrating public preferences into national coverage decision making. Reimbursement criteria considered outdated and changing societal expectations prompted the change. Both countries chose a deliberative process of public engagement with a multi-year commitment of many stakeholders to develop new reimbursement processes. Both countries' new reimbursement processes put a stronger emphasis on quality of life, the separation of individual versus societal perspectives, and the importance of final reimbursement decisions being taken in context rather than based largely on cost-effectiveness thresholds.
To face the growing financial pressure of sustainable funding of medicines, Belgium's and New Zealand's public payers have developed processes to engage the public in defining the reimbursement system's priorities. Although these countries differ in context and geographic location, they came up with overlapping lessons learnt which include the need for 1) political commitment to initiate change, 2) broad involvement of all stakeholders, and 3) commitment of all to engage in a long-term process. To evaluate these changes, further research is required to understand how coverage decisions in systems with and without public engagement differ.
公共医疗保健支付方组织面临越来越大的压力，需要对日益昂贵的处方药物做出透明且可持续的覆盖决策，这表明需要公众参与覆盖决策。然而，对于各国如何将公众偏好纳入现有资金决策，人们知之甚少。本研究旨在描述比利时和新西兰如何利用审议程序让公众参与，并确定从这些国家的方法中学到的经验教训。
为了描述两个国家的审议程序，我们首先审查了关键的国家政策文件，然后对来自比利时和新西兰的五位程序负责人进行了半结构化访谈。我们评估了每个国家让公众参与药物覆盖决策的理由和方法，并确定了经验教训。我们对访谈进行了定性内容分析，以描述关键主题和子主题。
在这两个国家，国家公共支付方组织发起并领导了将公众偏好纳入国家覆盖决策制定的过程。报销标准被认为过时，以及不断变化的社会期望促使了这一变化。两国都选择了公众参与的审议程序，并承诺多年来由许多利益相关者参与，以制定新的报销程序。两国新的报销程序更加注重生活质量，将个人与社会观点分开，并强调最终报销决策应根据背景做出，而不仅仅基于成本效益阈值。
为了应对可持续资助药品的日益增长的财务压力，比利时和新西兰的公共支付方已经制定了让公众参与定义报销系统优先级的程序。尽管这两个国家在背景和地理位置上存在差异，但它们提出了重叠的经验教训，包括：1）需要政治承诺来启动变革；2）广泛涉及所有利益相关者；3）承诺让所有人参与长期进程。为了评估这些变化，需要进一步研究以了解有公众参与和没有公众参与的系统中的覆盖决策有何不同。
