title: [Barriers for introducing a health technology assessment organization to inform health care decision-making in the Spanish National Health System].
abstract: BACKGROUND
  To identify difficulties, obstacles and limitations to establish an organizational structure devoted to the evaluation of healthcare technologies for incorporation, maintenance or removal from the services portfolio of the Spanish National Health System (sNHS).
  
  
  METHODS
  Panel of 14 experts, structured according to processes adapted from brainstorming, nominal group, and Rand consensus method techniques.
  
  
  RESULTS
  The panel proposed 77 items as potential obstacles to the establishment of an official and independent "agency" able to inform on sNHS healthcare benefits funding or selective disinvestment. These items were focused on: 1) lack of political motivation to introduce the cost-effectiveness analysis from the state and regional governments and lack of independence and transparency of the evaluation processes, 2) the tension between a decentralized health system and evaluation activities with significant scale economies, 3) technical difficulties of the evaluation processes, including their ability to influence decision making and 4) social and professional refusal to the exclusion of healthcare benefits when it is perceived as indiscriminate.
  
  
  CONCLUSIONS
  Although there is a different number and type of obstacles for developing the capacity of the sNHS to include or exclude healthcare benefits based on the evaluation of their effectiveness and efficiency, experts place in the political arena (political motivation, transparency, governance) the main difficulties to advance in this field.
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Artells
authors.forename: Salvador
authors.initials: S
authors.lastname: Peiró
authors.forename: Ricard
authors.initials: R
authors.lastname: Meneu
mesh_terms: D003659:Decision Making, Organizational; D006126:Group Processes; D015276:Health Care Rationing; D006291:Health Policy; D006801:Humans; D009313:National Health Programs; D013030:Spain