Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA 02115, USA.
Institute of Convergence Science (ICONS), Convergence Science Academy, Yonsei University, Seoul 03722, Korea.
Int J Environ Res Public Health. 2021 Aug 22;18(16):8846. doi: 10.3390/ijerph18168846.
To make more efficient use of limited resources, Vietnam incorporated health technology assessment (HTA) into the decision-making process for the health insurance benefit package in 2014. We evaluated progress in HTA institutionalization in Vietnam based on the theoretical framework developed by the National Institute for Health and Care Excellence and the Health Intervention and Technology Assessment Program, identified negative and conducive factors for HTA development, and finally suggested policy recommendations that fit the Vietnamese context.
Semi-structured in-depth qualitative interviews were conducted between December 2017 and March and April 2018 with a purposive sample of 24 stakeholders involved in decision-making for health insurance reimbursement. We employed thematic analysis to examine themes within the data.
Despite a variety of activities (e.g., training and advising/mentoring) and a substantial level of output (e.g., policy statements, focal points assigned, and case studies/demonstration projects), Vietnam has not yet reached the policy decision stage based on HTA with scientific integrity and active stakeholder participation. Most respondents, except some clinicians, supported the use of HTA. The lack of capacity of human resources in the government sector and academia, the limited data infrastructure, the absence of guidelines, the government's interest in immediate budget-saving, and public resistance were identified as barriers to the advancement of HTA.
A structured data repository, guidelines based on the Vietnamese context for both policy decision-making at the central level and daily clinical decision-making at the micro-level, and integration of a participatory process into HTA are suggested as priorities for HTA institutionalization in Vietnam.
为了更有效地利用有限的资源，越南于 2014 年将卫生技术评估（HTA）纳入医疗保险福利包的决策过程。我们根据国家卫生与保健卓越研究所和卫生干预与技术评估计划制定的理论框架，评估了越南 HTA 制度化的进展情况，确定了 HTA 发展的不利和有利因素，最后提出了符合越南国情的政策建议。
2017 年 12 月至 2018 年 3 月和 4 月，我们对 24 名参与医疗保险报销决策的利益攸关方进行了半结构式深入定性访谈。我们采用主题分析方法来审查数据中的主题。
尽管开展了各种活动（例如培训和提供建议/指导），并且取得了相当多的成果（例如政策声明、指定的联络点以及案例研究/示范项目），但越南尚未根据具有科学完整性和积极利益攸关方参与的 HTA 做出政策决策。除了一些临床医生外，大多数受访者都支持使用 HTA。政府部门和学术界人力资源能力不足、数据基础设施有限、缺乏指南、政府对节省预算的兴趣以及公众的抵制被认为是 HTA 发展的障碍。
建议将建立结构化的数据存储库、基于越南国情的指南（用于中央层面的政策决策和微观层面的日常临床决策）以及将参与性过程纳入 HTA 作为越南 HTA 制度化的优先事项。
