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Understanding Health Technology Assessment

In the governance of health systems, stakeholder involvement has four major functions:

  • to improve the quality of information concerning the population’s values, needs, and preferences;
  • to encourage public debate over the fundamental direction of the health system
  • to ensure public accountability for the processes within and outcomes of the system; and
  • to protect the public interest.1

Processes that attempt to aid decisions need to consider how different stakeholders can be involved in the process to ensure legitimacy of the decision. Decision-making processes are often overseen by a decision-making committee including individuals with different areas of expertise. The membership composition of a decision-making committee may be constrained by the possible impact of decisions, the resources available to support the committee, or the type of technology assessment being undertaken. Discussion frequently occurs about who should be involved in the decision-making committee and the potential conflicts of interest they may have. As everyone within a given health system is affected by decisions about the payment for and use of technologies, a fair approach to recommendations is needed that considers as many views as possible.

StakeholderAdvantages/disadvantages
PatientPatients can shed light on what it is like to have the illness, but an individual patient may disproportionately represent the needs of their patient community against society at large.
CitizenA citizen may have an unbiased view but may lack knowledge regarding specific technical or medical questions and issues.
Medical expertA medical expert can provide clinical insight, but may disproportionately favour treating patients irrespective of cost.
Technology analystsAnalysts can provide insight into the complexities of the assessment, but it may be difficult for them to question the validity of the findings, specifically if they have conducted the analysis themselves.
Producer of technologyA technology producer (for instance, a pharmaceutical company) can provide special insight into the strengths and weaknesses of new technologies, but they will have a strong competing interest if the technology in question is not from their company or from a direct competitor’s.