Bringing ‘the public’ into health technology assessment and coverage policy decisions: From principles to practice
Section snippets
HTA and health technology policy
Health technology assessment is sandwiched between two policy arenas (Table 1): coverage policy making at the macro level, which defines the general scope of government obligations to cover health care services and how health technologies will be assessed, and coverage decision making at the meso level, which determines whether specific technologies fall within the coverage policies. For example, Canadian coverage policy dictates that all medically necessary services be covered and determines
Which publics?
The question of who constitutes ‘the public’ lurks behind every element of the framework discussed so far. While explicit questions about the selection of public representatives have been confined to the first section of Table 2, column 2, the same questions apply to the identification and selection of public consultants. Answers will be found in part through the articulation of organizational goals for public involvement and accountability. But careful reflection on the following is also
Discussion and policy prospects
The functions and activities described above provide a glimpse into what public involvement and accountability mechanisms are currently in place within some of the major HTA, HT policy advisory committees in Canada. In addition to these current practices, we also identified initiatives on the horizon including a proposal for stakeholders (including patient groups) to be brought into the new Canadian HTA strategy [1], and plans to experiment with different public involvement approaches [60]. We
Acknowledgements
Research assistance for this project was supported in part by the Medicare Basket grant funded by the Canadian Health Services Research Foundation. We are grateful to Kristina Powles and Francois-Pierre Gauvin for their assistance in collecting data for this project and Terry Martens for her assistance in formatting the manuscript. Julia Abelson is supported by a Canadian Institutes of Health Research New Investigator Award. Pascale Lehoux is supported by a Canada Research Chair on Innovations
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