title: Development and implementation of health technology assessment in Argentina: two steps forward and one step back.
abstract: OBJECTIVE
  The objectives of this study are to review the financing and organization of the Argentine healthcare system, the licensing and drug price setting mechanisms, the benefit packages and coverage policies of pharmaceuticals and other medical technologies, as well as the development of HTA in Argentina, and the role of the Institute of Clinical Effectiveness and Health Policy (IECS) as an HTA agency. Finally, the perspectives and future of HTA as a tool to make resource-allocation decisions and priority setting in Argentina is discussed.
  
  
  METHODS
  The study is a discussion/review based largely on the experiences of the authors, but supported by available literature.
  
  
  RESULTS
  Argentina is an upper-middle income country with major healthcare problems related to both equity and efficiency. Its healthcare system consists of a multitier system divided in three large sectors: public, social security, and private, where the federal Ministry of Health has a rather limited role in national health policy stewardship. Many of Argentina's shortcomings are due in part to its pluralistic and fragmented healthcare system. In the past decade, Argentina, like many other Latin American countries, has undergone a profound reform of its healthcare system. Whereas some of the objectives of the reforms were specific to each country, a common issue among all of them was to establish a mechanism that ensured a more efficient allocation of scarce resources, and guaranteed a wider provision of healthcare services on the basis of the local population needs and equity. Although some signals from the national government and congress show that there are plans to formally incorporate HTA to inform reimbursement policies, these signals are still very weak. Paradoxically, even though Argentina was the first country in the region to require formal health economic evidence for the adoption of technologies into the mandatory benefit package of the social security, this "fourth hurdle" is no longer required. Nevertheless, there is an increasing interest and demand for a more explicit and transparent resource-allocation process that include HTA as a formal tool to inform decision making, in most of Argentine healthcare stakeholders.
  
  
  CONCLUSIONS
  In conclusion, what is needed in Argentina is a clear political will to push forward for a national agency of HTA that, similar to other developed countries, advance the regulation on the adoption of new health technologies to improve not only technical or allocative efficiency, but also health equity. Until this milestone is accomplished, the HTA production and use to inform healthcare coverage policies will continue to mirror the current fragmented healthcare system.
authors.affiliation: Institute of Clinical Effectiveness and Health Policy and Hospital Italiano de Buenos Aires, Argentina. arubinstein@iecs.org.ar
authors.forename: Adolfo
authors.initials: A
authors.lastname: Rubinstein
authors.forename: Andrés
authors.initials: A
authors.lastname: Pichon-Riviere
authors.forename: Federico
authors.initials: F
authors.lastname: Augustovski
mesh_terms: D001118:Argentina; D004059:Diffusion of Innovation; D016730:Program Development; D013673:Technology Assessment, Biomedical