title: The role of health technology assessment on pharmaceutical reimbursement in selected middle-income countries.
abstract: OBJECTIVE
  Middle-income countries are often referred to as developing or emerging economies and face multiple challenges of severe financial stresses in their health care sectors, and high disease burden. The objective of this study is to provide an overview of how health technology assessment (HTA) is used and organized in selected middle-income countries and its role in the process of pharmaceutical coverage.
  
  
  METHODS
  We selected middle-income countries where HTA activities are evident: Argentina, Brazil, China, Colombia, Israel, Mexico, Philippines, Korea, Taiwan, Thailand, and Turkey. We collected and reviewed relevant information to describe the health care and reimbursement systems and how HTA relates to coverage decision-making of pharmaceuticals. This was supplemented by information from a structured survey among professionals working in public and private health insurance, industry, regulatory authorities, ministries of health, academic units or HTA.
  
  
  RESULTS
  All countries require market authorization for pharmaceuticals to be sold and most countries have a national plan defining which pharmaceuticals can be reimbursed. However, the use of HTA in reimbursement decisions is still in its early stages with varying levels of HTA guidance implementation.
  
  
  CONCLUSIONS
  The study provides evidence of the development of HTA in coverage decision-making in middle-income countries. Increased health care spending and the resulting access to modern technology give a strong impetus to HTA. However, HTA is developing with uneven speed in middle-income countries and many countries are building on the organisational and methodological experience from established HTA agencies.
authors.affiliation: ECORYS NL, Division Macro Sector Policies, Watermanweg 44, 3067 GG Rotterdam, The Netherlands. Wija.oortwijn@ecorys.com
authors.forename: Wija
authors.initials: W
authors.lastname: Oortwijn
authors.forename: Judith
authors.initials: J
authors.lastname: Mathijssen
authors.forename: David
authors.initials: D
authors.lastname: Banta
mesh_terms: D001118:Argentina; D001938:Brazil; D002681:China; D003105:Colombia; D003659:Decision Making, Organizational; D003906:Developing Countries; D004335:Drug and Narcotic Control / Q000458:organization & administration; D033161:Government Regulation; D006302:Health Services Research; D006801:Humans; D019458:Insurance Coverage / Q000458:organization & administration*; D007356:Insurance, Pharmaceutical Services / Q000191:economics*; D007557:Israel; D008389:Marketing of Health Services; D008800:Mexico; D009313:National Health Programs / Q000458:organization & administration; D010679:Philippines; D012051:Reimbursement Mechanisms / Q000458:organization & administration*; D056910:Republic of Korea; D013624:Taiwan; D013673:Technology Assessment, Biomedical / Q000458:organization & administration*; D013785:Thailand; D014421:Turkey