Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, the Netherlands.
Health Econ Policy Law. 2021 Oct;16(4):457-472. doi: 10.1017/S1744133120000341. Epub 2020 Sep 21.
Health care coverage decisions may employ many different considerations, which are brought together across two phases. The assessment phase examines the available scientific evidence, such as the cost-effectiveness, of the technology. The appraisal then contextualises this evidence to arrive at an (advised) coverage decision, but little is known about how this is done.In the Netherlands, the appraisal is set up to achieve a societal weighing and is the primary place where need- and solidarity-related ('necessity') argumentations are used. To elucidate how the Dutch appraisal committee 'constructs necessity', we analysed observations and recordings of two appraisal committee meetings at the National Health Care Institute, the corresponding documents (five), and interviews with committee members and policy makers (13 interviewees in 12 interviews), with attention to specific necessity argumentations.The Dutch appraisal committee constructs necessity in four phases: (1) allowing explicit criteria to steer the process; (2) allowing patient (representative) contributions to challenge the process; (3) bringing new argumentations in from outside and weaving them together; and (4) formulating recommendations to societal stakeholders. We argue that in these ways, the appraisal committee achieves societal weighing rationality, as the committee actively uses argumentations from society and embeds the decision outcome in society.
医疗保健覆盖决策可能会考虑许多不同的因素,这些因素在两个阶段中结合在一起。评估阶段会考察技术的可用科学证据,如成本效益。然后评估会将这些证据置于特定背景下,以做出(建议的)覆盖决策,但对于如何进行评估知之甚少。在荷兰,评估旨在实现社会权衡,是使用与需求和团结相关(“必要性”)论证的主要场所。为了阐明荷兰评估委员会如何“构建必要性”,我们分析了荷兰国家卫生保健研究所两次评估委员会会议的观察结果和记录、相应的文件(五份)以及对委员会成员和政策制定者的访谈(十二次访谈中有十三位受访者),重点关注特定的必要性论证。荷兰评估委员会通过四个阶段构建必要性:(1)允许明确的标准来引导流程;(2)允许患者(代表)提出意见来挑战流程;(3)从外部引入新的论证并将其融合在一起;(4)向社会利益相关者提出建议。我们认为,通过这些方式,评估委员会实现了社会权衡的合理性,因为委员会积极利用社会的论证,并将决策结果融入社会。