The Impact of Health Technology Assessment for the Support of Universal Health Coverage in Thailand

According to World Health Organization (WHO) health system framework an efficient health system results in equitable access to essential health technologies with assured quality, safety, efficacy, and cost-effectiveness. National policies, essential health technology list, and evidenced-based selection of health technologies using health technology assessment (HTA) are needed to promote such access and rational use of health technologies. Globally, a growing commitment to universal health coverage (UHC) is promoting the role of HTA to support evidence-informed policy. Although the use of HTA is likely to produce higher healthcare investment related to process of introducing new health technologies into the benefits package, there are benefits in terms of improvement in health outcomes due to expanded coverage and efficient health technology choices. Despite limited resources, there is a growing pressure on the government to include new high-cost technologies in public health insurance schemes. HTA has been advocated as a necessary activity to ensure the efficient use of resources and improvement of coverage decisions. HTA is commonly referred to as a multidisciplinary field of policy analysis that considers technical performance, safety, clinical efficacy and effectiveness, cost and cost-effectiveness, organizational implications, social consequences, and legal and ethical consequences of the use of a health technology.   HTA in Thailand plays an important part in healthcare coverage decisions at the country level, including the development of the National List of Essential Medicines since 2008 – the pharmaceutical reimbursement list - and the Universal Coverage Benefits Package (UCBP) – the non-pharmaceutical benefits lists since 2009. In the past decade, a hundred health technologies have been evaluated under HTA programmes, which were mainly funded by public organisations. This illustrates the public effort for HTA institutionalisation in Thailand in terms of resource investment and using HTA for decision making. Even where the public sectors have spent on building the HTA infrastructure, there is little evidence that showing the impact of HTA towards budget allocation, efficiency, and outcomes in health system. Thus, this study aims to evaluate impact of HTA towards value for money and health outcomes as a result of HTA activities in development of the National List of Essential Medicines (NLEM) and UCBP. In addition, it can help to demonstrate the value of continued and strengthened investment in HTA in Thailand as well as to serve as an example to other Low- and Middle-Income Countries (LMICs).