美国、加拿大与澳大利亚的卫生技术评估

以美国、加拿大和澳大利亚为例,回顾了卫生技术评估发展历史、体系结构、参与各方以及对于卫生政策的影响.其对我国卫生技术评估的发展提供了可借鉴的经验.     

西班牙卫生技术评估的发展应用及启示

西班牙卫生技术评估的发展在全球是成功经验之一,经过多年发展,西班牙已经建立了较为成熟的卫生技术评估体系。通过文献复习,总结了西班牙卫生技术评估工作的基本特征、地位、决策过程、医院卫生技术评估发展的相关经验。提出了将HTA作为政府卫生政策的重要工具,加强卫生技术评估协作网建设,大力发展医院卫生技术评估,建立立体全面的卫生技术评估协作体系等政策建议。     

中国卫生技术评估的机遇和展望

从卫生技术的安全性、有效性、经济性和社会性4个角度阐述并分析了我国当前卫生技术存在的一些问题。我国卫生技术管理明显滞后于卫生技术发展的要求,卫生技术管理体制分散造成管理疏漏,卫生技术政策制定缺乏技术评估的循证支持。建议适当重构我国的卫生技术管理体系,协调各部门的职能,积极鼓励开展各种类型的技术评估研究,促进技术评估信息的公开透明。     

基于卫生技术评估构建医学人工智能技术临床应用评估路径的探讨

医学人工智能可以应用于疾病的预防、诊断和治疗等方面,以改善医疗服务的提供。卫生技术评估在国际上已广泛应用于新医药技术准入、医疗保险支付范围确定等方面。本文基于卫生技术评估,探讨构建我国医学人工智能临床应用评估路径,并提出了进一步发展的政策建议,为发展我国医学人工智能技术临床应用和卫生技术评估事业提供决策依据。     

荷兰卫生技术评估体系分析及对我国的启示*

目的：介绍荷兰卫生技术评估体系和政策转化现状，为完善我国价值医疗体系、提高卫生改革决策水平提供借鉴。方法：通过查阅国内外相关文献，描述荷兰的卫生技术评估体系，分析其常规应用的转化特点，综合评价其在新冠肺炎疫情中急性护理服务的网络构建特点。结果：荷兰卫生体系被称为“欧洲最佳医疗体系”，卫生技术评估在荷兰卫生系统决策中发挥了重要作用，特别是在降低医疗成本层面。相比荷兰，我国卫生技术评估政策转化成果相对较少。结论：我国需要完善卫生技术评估机构体系，加强研究人员与政策制定者的沟通，提升决策科学性及加快卫生技术评估转化效率。同时，筑牢分级诊疗体系，提升卫生技术评估综合性评价标准，进而推动实践价值医疗，促进我国卫生健康事业发展。     

我国卫生技术评估与决策转化研究概述

卫生技术评估在国际上已经得到广泛应用,并成为各国卫生决策的重要组成部分,发挥着越来越重要的作用。本文通过描述卫生技术的相关利益方,回顾卫生技术评估及转化的国际经验及潜在的影响因素,在结合我国卫生技术评估政策转化实际情况的基础上,提出了卫生技术评估知识转化程度测量、政策决策方和卫生技术评估研究方影响知识转化的因素挖掘以及转化程度测量等研究设想。     

研究者视角的中国卫生技术评估决策转化现状分析

目的 从研究人员视角描述中国卫生技术评估相关研究向决策转化的现状,并分析其中可能存在的影响因素,为促进我国卫生技术评估向决策转化提供建议.方法 采用问卷调查法和文献检索法,在全国范围内调查研究人员,收集研究人员对我国卫生技术评估现状、研究结果的政策转化和利用情况等观点.结果 研究共调查了382名研究人员.调查结果显示.尽管研究人员充分认可研究成果向政策转化的必要性,并且在进行选题时已经对决策转化有所考量,但多数卫生技术评估研究仍停滞在学术阶段,多数研究人员仅提交报告并在学术期刊上发表文章,仍缺乏决策转化的实际行动.此外,部分研究者未能获得充足的研究经费和时间,研究机构对卫生技术评估研究所给予的支持仍显不足,这些也是影响卫生技术评估向决策转化的重要原因.结论 有必要建立卫生技术评估研究必要的规范,以统一并提高研究质量,为决策转化打下坚实的基础：并完善卫生技术评估的研究系统,以保障研究经费、高素质的研究人员、多样化的研究成果传播渠道.     

卫生技术评估的国际经验及启示

比较详细地介绍了卫生技术评估的基本范畴、卫生技术评估在发达国家发展的经验以及我国的相关情况;分析了卫生技术评估发展的相关因素和支持条件;提出加快我国发展卫生技术评估的主要建议。     

国际创新卫生技术支付及定价政策进展及启示

创新卫生技术是促进我国卫生事业发展的重要支撑,但同时也是卫生费用增长的重要影响因素,建立具有激励和约束的创新卫生技术支付和定价是重要议题。文章从支付和定价两个方面,系统梳理了国际相关发展策略及进展,旨在为推进我国制定科学适宜的创新卫生技术支付和定价政策提供理论指导和参考依据。     

基于复杂适应系统理论的我国卫生技术评估实施机制研究

目的:探究我国卫生技术评估的实施现状和运行机制。方法:结合复杂适应系统理论,解析我国卫生技术评估实施的标识机制、积木块机制和内部模型机制。结果:从标识机制看,我国卫生技术评估的政策环境良好,但地方层面的机构体系和人才体系仍不成熟;从积木块机制看,不同的主体在卫生技术评估实施过程中有不同的工具,但方法指南和流程框架存在不权威、不透明的问题;从内部模型机制看,卫生技术评估的需方和供方之间的需求和预期成效沟通有限,导致研究成果不能转化为政策落实。结论:卫生技术评估是1个复杂适应系统,涉及到多方利益主体之间、主体与环境之间的交互作用,需要用系统的思维进一步重构实施机制。     

CT卫生技术评估报告分析及启示

目的为我国开展影像学诊断设备卫生技术评估（HTA）提供方法学参考。方法检索国际卫生技术评估机构网站,对纳入的CT HTA报告进行结构化信息提取和分析。结果共纳入4个国家6家机构的24篇HTA报告。其中,快速卫生技术评估12篇,全面卫生技术评估12篇。评估核心维度为有效性、经济性和安全性。纳入报告均采用了文献综述分析,部分针对重大决策的HTA进行了Meta分析、成本-效果分析和预算影响分析。 结论可为我国CT等影像学诊断设备技术评估提供参考,提高我国大型医疗设备治理决策的科学化水平。     

Ethics in health technology assessment: Understanding health technologies as policies

Health Technology Assessment (HTA) agencies strive to broaden their analyses to address more policy-relevant dimensions, including ethics. This trend has been described as transforming HTA to health technology policy analysis. A related social science concept, technology-as-policy, suggests useful directions for integrating ethics analysis into technology assessments. It challenges the HTA field to shift its focus from ethics to values and from evidence to intelligence. We describe these key concepts using recent Canadian and international innovations in HTA to illustrate promising trends.     

卫生技术评估国内外研究现状及应用

卫生技术评估（Health technology assessment，HTA）主要评估某项卫生技术的有效性、安全性、经济性和社会影响。它被广泛应用于卫生保健领域和医疗服务系统，其研究成果是卫生决策的重要依据。但HTA在我国的发展时间较短，仍属新领域，本文将对HTA的有关内容做一简要介绍，旨在推广这一新型评估技术的应用。     

Evaluation of new medicines in Spain and comparison with other European countries

ObjectiveTo compare the use of health technology assessment (HTA) as a tool to support pricing and reimbursement (P&R) of new medicines in Spain with England, Sweden, France and Germany.MethodFor each country, the literature is used to identify the purpose and timing of the P&R decision, the HTA and decision-making procedures used to generate evidence, and the criteria used to make decisions.ResultsResults are presented as a summary of the HTA landscape for P&R of new medicines in each country. Comparisons are made between Spain and other countries regarding the procedure and implementation of HTA.ConclusionsBased on these assessments, we made recommendations for how HTA might develop in Spain with the aim of improving governance and efficiency. Spain has made considerable progress in recent years, but still falls short of international standards in terms of independence of the HTA agencies and decision-making committees from political influence and industrial policy, the setting of prices of medicines in relation to health gain, improve the transparency of the process and results of the evaluation, and promote the participation of stakeholders. In common with other countries, Spain needs to clarify the role of cost-effectiveness criteria. Further progress needs to be made to coordinate effort across the various agencies, strengthen technical staff, and ensure equitable access to medicines between regions.     

Health technology assessment and the regulation of medical devices and procedures in Quebec. Synergy, collusion, or collision?

In this paper, we discuss the complex relationship between health technology assessment (HTA) and the regulation of medical devices and procedures. The relationship is first examined through a conceptual framework describing the itinerary from research to three levels of policy making: micro (standards of medical practice), meso (institutional rules), and macro (health policies). Four reports from the Quebec Health Technology Assessment Council (CETS) are used to illustrate how HTA activities can influence the regulatory mechanisms operating at each decision-making level. We then discuss the skillful balancing act required from HTA agencies to constantly negotiate the right distance from the regulatory process at which to operate. We propose that HTA agencies should not be incorporated into any regulatory, auditing, or monitoring process. Finally, the relationship between health technology assessment and health care reform is discussed. It is suggested that HTA activities will contribute most during the data-driven preparation and consolidation phases of a reform process. The fast pace of events and the political turmoil characteristic of the implementation phase provide a less receptive environment for HTA contributions.     

Health technology assessment: decentralized and fragmented in the US compared to other countries

This paper presents the results of the first comprehensive international survey to catalogue health technology assessment (HTA) activities. By 1995, there were formal HTA programs in 24 countries established mostly in the late 1980s and early 1990s. European countries generally have one or two federal or provincial HTA programs each, Canada has an extensive network of federal and regional organizations coordinated by a central body and the US has 53 HTA organizations, the vast majority of which are in the private sector. While the commitment of the US government to HTA has been erratic, the private sector has been witness to an expansion of HTA activities by insurance companies, hospitals, medical/device manufacturers, consulting firms and health professional societies. In contrast to other developed countries, the current state of technology assessment in the US is decentralized, fragmented and duplicative. We conclude by discussing the importance of a US HTA agency at the national level.     

Health technology assessment in Denmark

The Danish healthcare services are mainly provided by public sector institutions. The system is highly decentralized. The state has little direct influence on the provision of healthcare services. State influence is exercised through legislation and budget allocations. The main task of the state is to initiate, coordinate, and advise. Counties, which run the hospitals, also decide on the placement of services. The hospital sector is controlled within the framework of legislation and global budgets. General practitioners occupy a central position in the Danish healthcare sector, acting as gatekeepers to the rest of the system. The system works well, and its structure has resulted in steady costs of health care for a long period. There is no regulatory mechanism in the Danish health services requiring use of health technology assessment (HTA) as a basis for policy decisions, planning, or administrative procedures. However, since the late 1970s a number of comprehensive assessments of health technology have formed the basis for national health policy decisions. In 1997, after years of public criticism of the quality of hospital care and health technologies, and on the basis of a previously developed national HTA strategy, a national institute for HTA (DIHTA) was established. There seems to be a growing awareness of evidence-based healthcare among health professionals and a general acceptance of health economic analyses as a basis for health policy decision making. This progress is coupled with growing regional HTA activity in the health services. HTA seems to have a bright future in Denmark.     

A consumer involvement model for health technology assessment in Canada

Similar to other health policy initiatives, there is a growing movement to involve consumers in decisions affecting their treatment options. Access to treatments can be impacted by decisions made during a health technology assessment (HTA), i.e., the rigorous assessment of medical interventions such as drugs, vaccines, devices, materials, medical and surgical procedures and systems. The purpose of this paper was to empirically assess the interest and potential mechanisms for consumer involvement in HTA by identifying what health consumer organizations consider meaningful involvement, examining current practices internationally and developing a model for involvement based on identified priorities and needs. Canadian health consumer groups representing the largest disease or illness conditions reported a desire for involvement in HTA and provided feedback on mechanisms for facilitating their involvement.