Health Technology Assessment Aims

Health Technology Assessment aims to improve the performance of health systems. But what does a good health system look like? The WHO provided a definition of a ‘good health system’ in its World Health Report in 2000 [1] The report combines an expert assessment of global health, including statistics relating to all countries, with a focus on a specific subject. The main purpose of the report is to provide countries, donor agencies, international organisations and others with the information they need to help them make policy and funding decisions.

The WHO definition of a good health system:

‘A good health system delivers quality services to all people, when and where they need them. The exact configuration of services varies from country to country, but in all cases requires:

• a robust financing mechanism
• a well-trained and adequately paid workforce
• reliable information on which to base decisions and policies
• well maintained facilities and logistics to deliver quality medicines and technologies’

The WHO (World Health Report 2000) uses ‘fairness in financing’ to describe two related ideas:

• Protection of the individual from undue financial burden due to costs of illness.
• Equitable contributions to health system costs across income levels.

Fair financing means that the costs of the health system are distributed according to ability to pay rather than to the risk of illness: a fairly financed system ensures financial protection for everyone. Fair financing cannot be disassociated from equity that implies traditionally getting the services needed in return for contributing within an individual’s ability to pay.

1.1. The concept of equity in HTA

In the above context, equity refers to 'fairness' broadly. Practically, this often means fairness of access to care – that is, that the medicine in question is reasonably available to all who may benefit from it, regardless of factors largely unrelated to their health such as where they live and, in some health systems, their ability to pay.

The issue of equity is considered for new medicines but has been most prominent regarding highly specialised services. These are typically located in urban rather than rural areas, often in specialized centres or university-affiliated hospitals. Some examples include:

• New cancer medicines which require specific testing such as ‘companion diagnostic tests’ that may only be available in urban centres.
• Some medicines for intravenous administration (delivered directly into a vein) that may require a hospital or specialty clinic.
• For some rare diseases with small patient populations, where medical expertise is limited, centres of excellence may be established to coordinate care regionally or nationally.

Despite having an equitable health system, there is still considerable variation in access to healthcare. Depending on where they live, patients may have varying access to appropriate emergency care and treatment because not all services may be available locally.