Role of the Health Technology Assessment in Revising Health Insurance Benefits Package: Guiding or Shaping?

Nouhi, Mojtaba; Olyaeemanesh, Alireza; Jahangiri, Reza; Naderi, Mahdi

doi:10.18502/ijph.v49i11.4746

Cited by 1 publication

(2 citation statements)

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“…7 Pharmaceutical Management and Economics Research Center, Tehran University of Medical Sciences, Tehran, Iran. 8 Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran. 9 Health Equity Research Center, Tehran University of Medical Sciences, Tehran, Iran.…”

Section: Ethical Issuesmentioning

confidence: 99%

“…7 The Ministry of Health and Medical Education (MoHME) considers the revision of the health insurance benefit package (HIBP) as a top priority in its policy agenda, and as a means to ensure UHC and financial sustainability of the health system especially in the context of societal pressure to cover (expensive) emerging medical technologies. 5,8 The HIBP constitutes the secondary and tertiary level services that social health insurance agencies in Iran offer. It is complementary to the governmental health package offered by primary level facilities which comprises vaccination, screening services and mother and childcare.…”

Section: Introductionmentioning

confidence: 99%

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The Use of Evidence-Informed Deliberative Processes for Health Insurance Benefit Package Revision in Iran

Nouhi

Baltussen

Razavi

et al. 2022

Int J Health Policy Manag

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Background: Iran considers the revision of its health insurance benefit package (HIBP) as a means to achieve universal health coverage. Yet, its decision-making process has been criticised for being weak in terms of accountability and transparency. This paper reports on the development and implementation of the HIBP revision in Iran in the period 2019-2021, employing evidence informed deliberative processes (EDPs), a framework for benefit package design with the explicit aim of optimising the legitimacy of decision-making. Methods: The High Council for Health Insurance (HCHI) is coordinating the HIBP revision: it planned the six steps of the EDP framework with support from World Health Organisation and Radboudumc in 2019, and conducted a pilot project on multiple sclerosis diagnosis and treatment in 2020. Results: Implementation of the MS pilot project concerned the installation of advisory committees (involving some 60 stakeholders in supportive task forces, a technical working group and a national advisory committee), the selection of decision criteria (relating to quality of care, necessity, and sustainability), the inclusion of services for evaluation (nine in total), and the assessment and appraisal of these services. Conclusion: Implementation of the priority setting process for MS diagnosis and treatment services has likely improved the legitimacy of decision-making by involving stakeholders who engaged in deliberation based on available evidence in a stepwise, transparent process. It is expected to improve the quality of care for MS patients as well as its financial accessibility, at a zero net budget impact. The pilot project has served to help Iran’s health system move faster toward universal health coverage for a broader range of essential health services.

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Section: Ethical Issuesmentioning

confidence: 99%