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Equity in HTA: what doesn’t get measured, gets marginalised

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JournalIsrael Journal of Health Policy Research
DateAccepted/In press - 23 Jun 2017
DatePublished (current) - 10 Jul 2017
Issue number38
Volume6
Original languageEnglish

Abstract

When making recommendations about the public funding of new health
technologies, policy makers typically pay close attention to quantitative
evidence about the comparative effectiveness, cost effectiveness and budget
impact of those technologies – what we might call “efficiency” criteria. Less
attention is paid, however, to quantitative evidence about who gains and who
loses from these public expenditure decisions, and whether those who gain are
better or worse off than the rest of the population in terms of their health –
what we might call “equity” criteria. Two studies recently published in this
journal by Shmueli and colleagues suggest that this efficiency-oriented
imbalance in the use of quantitative evidence may have unfortunate
consequences – as the old adage goes: “what gets measured, gets done”. The first study, by Shmueli, Golan, Paolucci and Mentzakis, found that health
policy makers in Israel think equity considerations are just as important as
efficiency considerations – at least when it comes to making hypothetical
technology funding decisions in a survey. By contrast, the second study – by
Shmueli alone – found that efficiency rules the roost when it comes to making
real decisions about health technology funding in Israel. Both studies have
limitations and potential biases, and more research is needed using qualitative
methods and more nuanced survey designs to determine precisely which kinds
of equity consideration decision makers think are most important and why
these considerations do not appear to be given much weight in decision
making. However, the basic overall finding from the two studies seems
plausible and important. It suggests that health technology funding bodies
need to pay closer attention to equity considerations, and to start making
equity a quantitative endpoint of health technology assessment using the
methods of equity-informative economic evaluation that are now available.

Bibliographical note

© The Author(s). 2017

    Research areas

  • Equity, health technology assessment, health economics, economic evaluation, priority setting

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