title: Multicriteria decision analysis for including health interventions in the universal health coverage benefit package in Thailand.
abstract: OBJECTIVE
  Considering rising health expenditure on the one hand and increasing public expectations on the other hand, there is a need for explicit health care rationing to secure public acceptance of coverage decisions of health interventions. The National Health Security Office, the institute managing the Universal Coverage Scheme in Thailand, recently called for more rational, transparent, and fair decisions on the public reimbursement of health interventions. This article describes the application of multicriteria decision analysis (MCDA) to guide the coverage decisions on including health interventions in the Universal Coverage Scheme health benefit package in the period 2009-2010.
  
  
  METHODS
  We described the MCDA priority-setting process through participatory observation and evaluated the rational, transparency, and fairness of the priority-setting process against the accountability for reasonableness framework.
  
  
  RESULTS
  The MCDA was applied in four steps: 1) 17 interventions were nominated for assessment; 2) nine interventions were selected for further quantitative assessment on the basis of the following criteria: size of population affected by disease, severity of disease, effectiveness of health intervention, variation in practice, economic impact on household expenditure, and equity and social implications; 3) these interventions were then assessed in terms of cost-effectiveness and budget impact; and 4) decision makers qualitatively appraised, deliberated, and reached consensus on which interventions should be adopted in the package.
  
  
  CONCLUSIONS
  This project was carried out in a real-world context and has considerably contributed to the rational, transparent, and fair priority-setting process through the application of MCDA. Although the present project has applied MCDA in the Thai context, MCDA is adaptable to other settings.
authors.affiliation: Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand. sitaporn.y@hitap.net
authors.forename: Sitaporn
authors.initials: S
authors.lastname: Youngkong
authors.forename: Rob
authors.initials: R
authors.lastname: Baltussen
authors.forename: Sripen
authors.initials: S
authors.lastname: Tantivess
authors.forename: Adun
authors.initials: A
authors.lastname: Mohara
authors.forename: Yot
authors.initials: Y
authors.lastname: Teerawattananon
mesh_terms: D003661:Decision Support Techniques; D015276:Health Care Rationing; D006801:Humans; D007349:Insurance, Health, Reimbursement; D013785:Thailand; D019472:Universal Health Insurance / Q000191:economics / Q000458:organization & administration*