School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
J Med Econ. 2022 Jan-Dec;25(1):993-1004. doi: 10.1080/13696998.2022.2101807.
The Canadian province of Ontario provides full coverage for its residents (pop.14.8 M) for hospital-based diagnostic testing. Historical governance of the healthcare system and a legacy scheme of health technology assessment (HTA) and financing has led to a suboptimal approach of adopting advanced diagnostic technology (i.e. protein expression, cytogenetic, and molecular/genetic) for guiding therapeutic decisions. The aim of this research is to explore systemic barriers and provide guidance to improve patient and care provider experiences by reducing delays and inequity of access to testing, while benefitting laboratory innovators and maximizing system efficiency.
A mixed-methods approach including literature review, semi-structured interviews, and a multi-stakeholder forum involving patient representatives ( = 1), laboratory leaders ( = 6), physicians ( = 5), Ministry personnel ( = 4), administrators ( = 3), extra-provincial experts, and researchers ( = 7), as well as pharmaceutical ( = 5) and diagnostic companies ( = 2). The forum considered evidence of good practices in adoption, implementation, and financing laboratory services and identified barriers as well as feasible options for improving advanced diagnostic testing in Ontario.
Overarching challenges identified included: barriers to define what is needed; need for a clear approach to adoption; and the need for more oversight and coordination. Recommendations to address these included a shift to an anticipatory system of test adoption, creating a fit-for-purpose system of health technology management that consolidates existing evaluation processes, and modernizing the governance and financing of testing so that it is managed at a care-delivery level.
The proposals for change in Ontario highlight the role that HTA, governance, and financing of health technology play along the continuum of a health technology life cycle within a healthcare system where decision-making is highly decentralized. Resource availability and capacity were not a concern - instead, solutions require higher levels of coordination and system integration along with innovative approaches to HTA.
加拿大安大略省为其 1480 万居民提供了全面的医院诊断检测服务。该省的医疗保健系统历史上的治理结构以及传统的医疗技术评估（HTA）和融资方案导致其采用先进诊断技术（如蛋白质表达、细胞遗传学和分子/遗传学）来指导治疗决策的方法并不理想。本研究旨在探讨系统障碍，并通过减少检测的延迟和获得机会的不平等，为改善患者和护理提供者的体验提供指导，同时使实验室创新者受益并最大化系统效率。
采用混合方法，包括文献回顾、半结构化访谈以及多利益相关者论坛，涉及患者代表（ = 1）、实验室领导者（ = 6）、医生（ = 5）、卫生部人员（ = 4）、管理人员（ = 3）、省外专家和研究人员（ = 7），以及制药（ = 5）和诊断公司（ = 2）。该论坛考虑了采用、实施和资助实验室服务的良好实践的证据，并确定了在安大略省改善先进诊断检测的障碍和可行方案。
确定的主要挑战包括：界定需求的障碍；需要明确的采用方法；以及需要更多的监督和协调。为解决这些问题提出了建议，包括转向采用预期性测试系统，创建一个适合目的的医疗技术管理系统，合并现有的评估流程，以及使测试的治理和融资现代化，以便在提供护理的层面进行管理。
安大略省的变革建议强调了 HTA、医疗技术的治理和融资在医疗保健系统中沿着医疗技术生命周期的连续体中的作用，在这个系统中，决策高度分散。资源可用性和能力不是问题-相反，解决方案需要更高水平的协调和系统集成，以及创新的 HTA 方法。
