Evidence-based decision-making in Asia-Pacific with rapidly changing health-care systems: Thailand, South Korea, and Taiwan.
OBJECTIVE
To review the use of evidence in the market approval process, reimbursement, and price control mechanisms for medicines and medical devices in Thailand, South Korea, and Taiwan.


METHODS
Documentary reviews supplemented by interviews with senior policymakers of relevant public health authorities.


RESULTS
Drug regulatory authorities play a vital role in the market authorization process by considering evidence on safety, efficacy and quality for new medicines, and bio-equivalence for new generic products of previously patented medicines. For the formulation of the reimbursement list, all three cases applied evidence on cost-effectiveness, to various degrees, with clear institutional structure, capacity, and functions. Only Thailand has specified an explicit benchmark on cost-effectiveness for inclusion in the reimbursement list. For price control, all have established mechanisms and processes for price negotiation. These mechanisms apply evidence on cost structure and relative prices in other countries to ensure affordable prices, especially with the patented drug industry. Thailand's universal insurance schemes use a capitation payment model which proves effective in implicit price control. To increase access to essential medicines that have patents on and high price, Thailand applied Trade-Related Aspects of Intellectual Property flexibilities; "government use of patent," for public noncommercial purposes to seven essential drugs in 2006 to 2008.


CONCLUSIONS
Rapidly increasing health expenditure and universal health insurance systems have created greater requirement for proof of "value for money" in the approval and funding of new medical technologies. All settings have established clear mechanisms to apply appropriate evidence in the processes of market approval, reimbursement, and pricing control.
Jirawattanapisal
Thidaporn
T
International Health Policy Program, Ministry of Public Health, Muang Nonthaburi, Thailand. thidapor@health2.moph.go.th
Kingkaew
Pritaporn
P
Lee
Tae-Jin
TJ
Yang
Ming-Chin
MC
D003362:Cost-Benefit Analysis; D018795:Device Approval; D017277:Drug Approval; D019317:Evidence-Based Medicine / Q000191:economics*; D006291:Health Policy / Q000191:economics*; D006801:Humans; D056910:Republic of Korea; D013624:Taiwan; D013785:Thailand; D019472:Universal Health Insurance / Q000191:economics*