Evidence-Informed Deliberative Processes – Early Dialogue, Broad Focus and Relevance: A Response to Recent Commentaries

Jansen, Maarten; Baltussen, Rob; Mikkelsen, Evelinn; Tromp, Noor; Hontelez, Jan A. C.; Bijlmakers, Leon; Wilt, Gert Jan van der

doi:10.15171/ijhpm.2017.88

Cited by 4 publications

(2 citation statements)

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“…The overall concept of EDPs stems from the general principle of legitimacy, the definition of four elements is a practical translation of the Accountability for Reasonableness framework, 5 the definition of practical steps is based on existing HTA methods and tools, whereas related recommendations on best practices are inferred from observed practices of HTA bodies around the world. The development process itself was geared through academic knowledge exchange 15,[18][19][20][21][22][23][24][25][26][27][28] and the experience of implementing EDPs in several countries. We also surveyed HTA bodies and experts around the globe on their need for guidance.…”

Section: Development Of Practical Guidancementioning

confidence: 99%

Evidence-Informed Deliberative Processes for Health Benefit Package Design – Part II: A Practical Guide

Oortwijn¹,

Jansen²,

Baltussen³

2021

Int J Health Policy Manag

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Background. Countries around the world are using health technology assessment (HTA) for health benefit package design. Evidence-informed deliberative processes (EDPs) are a practical and stepwise approach to enhance legitimate health benefit package design based on deliberation between stakeholders to identify, reflect and learn about the meaning and importance of values, informed by evidence on these values. This paper reports on the development of practical guidance on EDPs, while the conceptual framework of EDPs is described in a companion paper. Methods. The first guide on EDPs (2019) is further developed based on academic knowledge exchange, surveying 27 HTA bodies and 66 experts around the globe, and the implementation of EDPs in several countries. We present the revised steps of EDPs and how selected HTA bodies (in Australia, Brazil, Canada, France, Germany, Scotland, Thailand and the United Kingdom) organize key issues of legitimacy in their processes. This is based on a review of literature via PubMed and HTA bodies’ websites. Results. HTA bodies around the globe vary considerable in how they address legitimacy (stakeholder involvement ideally through participation with deliberation; evidence-informed evaluation; transparency; and appeal) in their processes. While there is increased attention for improving legitimacy in decision-making processes, we found that the selected HTA bodies are still lacking or just starting to develop activities in this area. We provide recommendations on how HTA bodies can improve on this. Conclusion. The design and implementation of EDPs is in its infancy. We call for a systematic analysis of experiences of a variety of countries, from which general principles on EDPs might subsequently be inferred.

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Section: Development Of Practical Guidancementioning

confidence: 99%

Evidence-Informed Deliberative Processes for Health Benefit Package Design – Part II: A Practical Guide

Oortwijn¹,

Jansen²,

Baltussen³

2021

Int J Health Policy Manag

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“…The contexts across LLMICs where these packages need to be implemented are diverse and elude attempts at standardisation of implementation approaches. This contrasts with the relatively more standard approaches now available for designing UHC packages and deciding on priority health services 8 9…”

Section: Introductionmentioning

confidence: 99%

The role of the private sector in delivering essential packages of health services: lessons from country experiences

et al. 2023

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Many countries are adopting essential packages of health services (EPHS) to implement universal health coverage (UHC), which are mostly financed and delivered by the public sector, while the potential role of the private health sector (PHS) remains untapped. Currently, many low-income and lower middle-income countries (LLMICs) have devised EPHS; however, guidance on translating these packages into quality, accessible and affordable services is limited. This paper explores the role of PHS in achieving UHC, identifies key concerns and presents the experience of the Diseases Control Priorities 3 Country Translation project in Afghanistan, Ethiopia, Pakistan, Somalia, Sudan and Zanzibar. There are key challenges to engagement of the PHS, which include the complexity and heterogeneity of private providers, their operation in isolation of the health system, limitations of population coverage and equity when left to PHS’s own choices, and higher overall cost of care for privately delivered services. Irrespective of the strategies employed to involve the PHS in delivering EPHS, it is necessary to identify private providers in terms of their characteristics and contribution, and their response to regulatory tools and incentives. Strategies for regulating private providers include better statutory control to prevent unlicensed practice, self-regulation by professional bodies to maintain standards of practice and accreditation of large private hospitals and chains. Potentially, purchasing delivery of essential services by engaging private providers can be an effective ‘regulatory approach’ to modify provider behaviour. Despite existing experience, more research is needed to better explore and operationalise the role of PHS in implementing EPHS in LLMICs.

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Evidence-Informed Deliberative Processes for Legitimate Health Benefit Package Design − Part I: Conceptual Framework

Baltussen¹,

Jansen²,

Oortwijn³

2021

Int J Health Policy Manag

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Background. Countries around the world are increasingly rethinking the design of their health benefit packages to achieve universal health coverage and health technology assessment (HTA) bodies support governments in these decisions. Coverage decision-making is an intrinsically complex and value-laden political process, but value frameworks currently employed by HTA bodies do not sufficiently account for this complex reality. Methods. Several years ago, evidence-informed deliberative processes (EDPs) were developed to address this issue. An EDP is a practical and stepwise approach for HTA bodies to enhance legitimate health benefit package design based on deliberation between stakeholders to identify, reflect and learn about the meaning and importance of values, and to interpret available evidence on these values. We further developed the conceptual framework and initial 2019 guidance based on academic knowledge exchange, analysing practices of HTA bodies, surveying HTA bodies and experts around the globe, and implementation of EDPs in several countries around the world. Results. EDPs stem from the general concept of legitimacy, which is translated into four elements – stakeholder involvement ideally operationalised through stakeholder participation with deliberation; evidence-informed evaluation; transparency; and appeal. The 2021 practical guidance distinguishes six practical steps of a HTA process and provides recommendations on how these elements can be implemented in each of these steps. Conclusion. There is an increased attention for legitimacy, deliberative processes for HTA and health benefit package design, but the development of theories and methods for such processes remain behind. The added value of EDPs lies in the operationalisation of the general concept of legitimacy into practical guidance for HTA bodies.

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Evidence-Informed Deliberative Processes – Early Dialogue, Broad Focus and Relevance: A Response to Recent Commentaries

Cited by 4 publications

References 8 publications

Evidence-Informed Deliberative Processes for Health Benefit Package Design – Part II: A Practical Guide

Evidence-Informed Deliberative Processes for Health Benefit Package Design – Part II: A Practical Guide

The role of the private sector in delivering essential packages of health services: lessons from country experiences

Evidence-Informed Deliberative Processes for Legitimate Health Benefit Package Design − Part I: Conceptual Framework

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