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Institutionalising HTA in Slovenia

Country: 
Slovenia
Partner Institute: 
Institute of Public Health of the Republic of Slovenia, Ljubljana
Survey no: 
(16)2010
Author(s): 
Tit Albreht
Health Policy Issues: 
Pharmaceutical Policy, Funding / Pooling, Benefit Basket, Others, Remuneration / Payment
Others: 
HTA
Reform formerly reported in: 
HTA in Slovenia - new developments
Current Process Stages
Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no yes yes yes no no

Abstract

Slovenia is lagging behind other EU member states in developing a formal basis for HTA development. After eight years of discussions, the MoH now proposed an organisational structure, which would represent the institutionalisation of HTA in Slovenia. Two new bodies would be formed - an HTA council and an HTA network. They would have a supervisory (the council) and a technical role (the network). These two structures would form a service, which would both deliver HTA studies and carry priorities.

Recent developments

The first serious initiatives on institutionalising Health Technology Assessment (HTA) in Slovenia were presented during the government term 2000-2004, when it had been envisaged to place this function within the formation of an Institute for Quality in Health Care. Later, there were several more attempts, but none of them resulted in any serious outcome. In the current government term (2008-2012), the Ministry of Health (MoH) became aware of the fact that HTA was missing as an important step towards a procedure for decision making on a national level. Although its elements were introduced into everyday practice of decision making about new health care programmes and technologies already, this was insufficient. HTA was done on a voluntary basis and mostly carried out by medical specialists, who very often were incapable of carrying out a complex economic evaluation.

It took until 2010 that these ideas resulted in a proposal that envisages both the formation of a decision making body, as well as institutions and individuals practicing HTA for practical use in health care.

HTA has been present in Slovenia for more than a decade, but it was only recently that specific structures were put forward in the different decision making processes. The institutionalization of HTA should ensure the daily practice and responsiveness, and the optimal use of resources (given that in many small EU-member states it is difficult to secure expertise for a rather specific field, such as HTA).

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Characteristics of this policy

Degree of Innovation traditional rather innovative innovative
Degree of Controversy consensual rather consensual highly controversial
Structural or Systemic Impact marginal rather fundamental fundamental
Public Visibility very low high very high
Transferability strongly system-dependent rather system-neutral system-neutral
current current   previous previous

The proposed solution represents a significant change in the approach, compared to how similar issues were solved in the past. The concept of combining a steering committee and a network of interested parties is a relative novelty. In the past the Government would resort to the establishment of agencies instead. While this is neither feasible nor desireable in the present economic situation, it remains to be seen if the proposed solution will be sustainable in the long run.

Purpose and process analysis

Current Process Stages

Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no yes yes yes no no

Initiators of idea/main actors

  • Government

Stakeholder positions

Taking into account the relationships between the key stakeholders the setting of HTA is a compromise. Even though HTA in many aspects has a public health function, such a new role for the National Institute of Public Health (NIPH) has often been contested. There are three aspects of HTA policies in Slovenia that will have to be respected:

1. HTA serves as a broader concept for other similar assessments, but offers a certain market opportunity given that there can (will?) be several providers of these assessments. There are several providers of HTA who actually prepare assessments based on those being commissioned by different bodies. They include the Institute of Economic Research in Health Care, the Faculty of Economics in Ljubljana, the Institute for Economic Research in Ljubljana, and the Faculty of Pharmacy.

2. HTA serves as an evaluation mechanism, which is defined as an interface between the providers of technologies and policy-makers, and in principle it is performed as scrutinising reports prepared under the previous point.

3. HTA serves as a network with transparent and open mechanisms of co-ordination across a larger number of interested partners.

Actors and positions

Description of actors and their positions
Government
Institute of Public Healthvery supportivesupportive strongly opposed
Pharmaceutical industryvery supportiveneutral strongly opposed
Health Insurance Institutevery supportivesupportive strongly opposed
Faculty of Pharmacyvery supportivesupportive strongly opposed
current current   previous previous

Influences in policy making and legislation

The legal background for the proposed solution will be based on statutes and regulations adopted by the Minister and later adopted by the Health Council, which is his main advisory body.

A new level of concensus was reached, which is that an HTA Steering Committee and a Network would be formed. These would ensure the carrying out of the necessary steps of the HTA process and the representation of all interested partners. These two aspects ensured the consent from those who earlier opposed the intermediate proposed solution, especially with respect to defining the NIPH as the location for all national key HTA activities.

Actors and influence

Description of actors and their influence

Government
Institute of Public Healthvery strongneutral none
Pharmaceutical industryvery strongstrong none
Health Insurance Institutevery strongvery strong none
Faculty of Pharmacyvery strongstrong none
current current   previous previous
Institute of Public HealthFaculty of PharmacyHealth Insurance InstitutePharmaceutical industry

Positions and Influences at a glance

Graphical actors vs. influence map representing the above actors vs. influences table.

Adoption and implementation

The committee or HTA Council will have members from all key institutions related to the HTA process as assessed by the MoH, including representatives of the MoH, the Health Insurance Institute of Slovenia (HIIS), the two clinical centres in Ljubljana and Maribor, the National Institute of Public Health (NIPH), the Medical Chamber, the Nursing Chamber and the Chamber of Pharmacy.   The network shall include all those institutions interested in contributing to the HTA issues, being either at the level of interested parties or providing any part of the assessment. In that sense the network will include the representatives of the HIIS, NIPH, Faculty of Pharmacy, other institutes dealing with HTA (see below) and representatives of the industry.

Expected outcome

The policy should be decided upon in the near future, meaning in the next 1-3 months, depending on the level of agreement between the MoH and the interested parties. This area will certainly remain a focus of attention in these reports and will be treated with a lot of interest.   The exact description of the processes will be possible once the final versions of the respective regulations are adopted and then implemented. This process will be monitored and reported on.

Impact of this policy

Quality of Health Care Services marginal neutral fundamental
Level of Equity system less equitable neutral system more equitable
Cost Efficiency very low high very high
current current   previous previous

It is expected that this mechanism will be an important step in improving the process and the mechanisms of HTA evaluation, and that it will serve as the base for informed health policy decision-making in Slovenia.

References

Sources of Information

1. Draft regulations for the formation of the HTA Steering Committee and the HTA Network, prepared by the MoH of Slovenia - materials for discussion with the Health Council (in Slovene)

Reform formerly reported in

HTA in Slovenia - new developments
Process Stages: Evaluation, Policy Paper, Pilot

Author/s and/or contributors to this survey

Tit Albreht

Suggested citation for this online article

Tit Albreht. "Institutionalising HTA in Slovenia". Health Policy Monitor, October 2010. Available at http://www.hpm.org/survey/si/a16/2