LIST OF PANELS

Health Technology Assessment (HTA) has become a central feature of policy-making in health systems across the globe over the past two decades. This multidisciplinary activity promises to reduce inefficiency and waste, and to facilitate more rational decision-making on health system coverage, thus enhancing sustainability. However, the nature of its intersection with the policy process remains problematic and relatively poorly understood. Moreover, since HTA impacts directly or indirectly on allocative decision-making in health systems, it frequently generates significant controversy, thus undermining attempts by policy-makers to utilise the activity as a means of depoliticising hard choices in healthcare.    This panel seeks to provide a platform for the critical analysis of HTA’s relationship to policy-making and papers are invited on this theme. Consistent with the multidisciplinary nature of HTA as an activity, contributions may come from a broad range of perspectives, including (but not restricted to): economics, ethics, health policy, law, philosophy, political science/theory and sociology. The panel will explore both the theory and the practice of HTA and papers which consider the operation of HTA in low and middle-income countries and/or which take a comparative approach are especially welcome.                   Possible topics might include: • HTA and the courts • The democratic legitimacy of HTA decision-making • HTA at supranational level • Institutional and process design for HTA • Participation in HTA • Inclusion of ‘social values’ in HTA • HTA decisional criteria and the goals of health systems However, please note that this is not intended to be an exhaustive list, and papers on any topic at the intersection of HTA and public policy will be considered for inclusion in the panel.  

Defined as a ‘multidisciplinary field of policy analysis which incorporates the medical, social, economic and ethical implications of development, diffusion and use of health technology’ (World Health Organization, 2008) and forming a bridge between scientific/social-scientific research and policy, health technology assessment (HTA) is an increasingly important activity globally. Both the World Health Assembly and the European Union have recently taken steps to promote the systematic evaluation of the clinical and cost-effectiveness of technologies and interventions in response to concerns as to the ongoing financial sustainability of health systems. The attention being accorded to this activity by supranational bodies such as these follows in the wake of the establishment of HTA institutions, processes and programmes in significant numbers of high-income countries from the late 1980s onwards and, more recently, similar developments in middle-income nations.   Yet, notwithstanding its growing centrality as a means of informing rational choices on healthcare coverage and priority-setting by decision-makers, HTA continues to be a highly controversial dimension of contemporary public policy. Important concerns include those relating to the scope of stakeholder participation in assessment processes and the possibility of HTA agency capture (especially by ‘big pharma’), the democratic legitimacy of a seemingly ‘technocratic’ mode of decision-making, the relationship between the criteria which inform HTA and the goals of a health system, the potential  of HTA to act as a regulatory obstacle to research and innovation, and the extent to which HTA decision-making processes give effect to principles of procedural justice. In addition, there is significant variability in the manner in which HTA is given practical effect across systems: for example, in institutional structures and processes, impact on pricing and access, mechanisms for accountability and enforceability through law. These distinctions are exacerbated by significant differences in capacity between states operating forms of HTA.   This panel seeks to explore the potential of, and problems generated by, HTA as a tool of public policy and to offer a forum for comparative analysis of experience with this activity to date. Consistent with the multidisciplinary character of the field, the first session of the panel will consist of papers presented from four different perspectives; namely, legal, ethical, political/institutional and economic. Each of these papers will be underpinned by the cross-cutting theme of legitimacy, a concept regularly problematized in the literature on resource allocation in healthcare and which has been influential in shaping the evolution of HTA in various settings (for example, the shift by the United Kingdom’s NICE from a technocratic to a more inclusive and deliberative approach). Further contributions will be invited with a view to scheduling additional sessions of the panel: possible topics of interest might include HTA in the courts, the place of social values in HTA decision-making, analysis of the role of HTA in middle-income countries, HTA and the ‘pharmacization’ of public health, and the impact of regional and international HTA networking on health policy at national level.