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Revista médica de Chile

versión impresa ISSN 0034-9887

Rev. méd. Chile vol.142  supl.1 Santiago ene. 2014 



Health Technology Assessment


Marianela Castillo-Riquelme, Manuel Antonio Espinoza S.


Clinical practice has advanced in recognizing the evidence, as the essential source in the decision-making process at the physician-patient level. At the central level, at the other end, the health authority responsible for the health of the population has also made this recognition when deciding what interventions should be made available to physicians and patients. This has been explicit for example in the implementation of "Explicit Health Guarantees" (GES), whose package of services is supported by a review of the available evidence. However, despite these advances seen in recent years, Chile still lacks a systematic process of evaluation of the relevant evidence, including economic, social and legal aspects, in a framework that ensures the social legitimacy of coverage decisions of old and new health interventions.

Health technology assessment (HTA) corresponds to the research that examines the technical, social, economic, ethical and legal consequences from the use of health technologies (or interventions), which occur in the short and long term and which can be both direct and indirect and can apply on the desired as well as on the unwanted effects. HTA, understood as a multidisciplinary area, has seen a great development during the last 20 years, resulting in the implementation of HTA agencies or institutes in most high-income countries of the world. The dilemma of prioritizing among health technologies and the increasingly dynamic proliferation of new technologies, which put pressure on health systems to be included, affect not only developed countries. This has led to international organizations to promote HTA implementation in all countries. In this context, Chile has taken an important step in recognizing HTA as health policy, through the creation of the National Commission for Health Technology Assessment in December 2012, whose main objective is to propose a HTA model, with views to be implemented in Chile.

It is recognized the role that health professionals have in determining the demand for health care, as in many cases their decisions define which diagnostic and therapeutic arsenal should be incorporated into the financial coverage schemes. Doctors, nurses and other health professionals have developed skills in evidence evaluation processes in the last 20 years, which has been accompanied by the development of evidence-based medicine. However, coverage decisions require considerations of health technology that go beyond the effectiveness and safety of these interventions. These additional elements include the opportunity cost of allocating health resources (efficiency) and the distribution of expected outcomes (equity), among others. Given the importance of these elements in the decision making process and the need for having health professionals able to take part in this discussion, is that it is essential to inform and train health professionals in the HTA processes.

International experience indicates that the professionals that have sympathized more with HTA are precisely the clinicians, as HTA granted them a validated and legitimate tool to address patient-level decisions without compromising consequences in other patients. This tool is even more valued when health care professionals are in charge of clinical and hospital management, and are forced to make or implement decisions in health care. On the other hand, a central element in the HTA process to indentify information gaps and the establishment of a judgment on the need to allocate resources to research, in order to resolve uncertainty which limits taking right decisions in the health system. Because many health professionals are also researchers in health care, it seems necessary that our professionals incorporate these additional elements in their work as researchers.

HTA has been developed in the world since the early seventies and in the last decade it has reached more formality in Latin America especially in countries like Brazil, Mexico, Colombia and Uruguay. The amount of HTA studies has grown in the last decade and it is expected that this increase will continue, due to the needs these agencies will have. The impact that HTA has had and is having in the performance of health systems internationally, implies that there is a need of reviewing and disseminating the most relevant aspects of HTA in our community of health professionals. This is the motivation that led to this series of articles, which are not intended to address in detail all elements of HTA, but to provide an overview of the key elements. Each article reviews the conceptual foundations of the subject and examines the international experience in this regard, and then it applies its content to the Chilean context, identifying in many cases the remaining challenges.

We extend a warm invitation to all health professionals, especially to the medical doctors' community of our country to read this supplement and get involved in the implementation of HTA processes from their places of work, scientific societies or union representation. We expect that the general aspects addressed in this supplement serve to unify the language that we hope to speak nearly in the future in the decision processes related to health care technologies.

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