Same same but different

by Deepika Adhikari
Category : In-Country Experience, Learning

Vietnam visit 30th and 31st May 2017

It feels good to see familiar faces when you are in a new place and I felt the same meeting officials from Health Strategy Planning Institution (HSPI), Ministry of Health of Vietnam once again. I had met them earlier during the HTAsiaLink conference held in April 2017 in Hanoi, Vietnam. They were also the organizers for the same.  HTAsiaLink is a network of Health Technology Assessment (HTA) agencies in Asia-pacific region and this network has over 14 member countries.  This network facilitates HTA research and collaboration between member countries.

It also felt very good to represent Health Intervention Technology Assessment Program (HITAP) as a member of this delegation because I am new to HITAP. It has been just over 3 months since I joined. I come from a small country (Bhutan) and we have a different health system there; the healthcare services are provided free of cost to everyone residing in Bhutan. There are no health security schemes; the only scheme followed is the Universal Health Coverage for all.

The purpose of this visit was to discuss on potential topics of near future collaborations between Ministry of Health (MoH) of Vietnam and HITAP in the areas of HTA.

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A former employee of HSPI had once proposed for a threshold analysis study as she probably realized that having a threshold helps countries to set standards in deciding whether or not an intervention should be included in their health benefits package. Now HSPI and MoH together deem it necessary and it has become more of a priority; there is also demand from stakeholders and partners. Their other area of interest was to have an HTA guideline that helps determine inclusion of various health technologies in their health benefits package. They also showed a keen interest in learning about pharmacoeconomics as it could help a newly established office under the purview of MoH, (National Center for Drug Procurement) in price negotiation with the drug companies. Pharmacoeconomics plays a key role in shaping the health expenditure and in evidence-informed decision making.

We discussed that economic evidence is not generalizable between countries because in different countries the health care provided, the health facilities and especially currencies vary a lot. However, having said that, transferability is still allowable; information can be borrowed but it needs to be adjusted to the country’s context.

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Coming to the development of HTA guidelines we suggested that in addition to the HTA methods guideline, they should develop a process guideline too because not only is it targeted to guide the HTA researchers but it can also serve as an education tool for various levels of stakeholders and decision makers. Bhutan too has developed an HTA guideline that has more to do with processes and it is being used as an education tool in sensitizing the Bhutanese health system about the importance of HTA and the HTA processes. Perhaps Vietnam could do the same with their process guideline too.

We also had the opportunity to meet the Director of Department of Health Insurance (DHI), MoH and his interest lied in learning the best ways to choose drugs for inclusion in their Essential Medicines List (EML). We responded setting an example of the Thai National List of Essential Medicines (NLEM) and the Thai National Medicines’ Formulary. The NLEM has medicines listed in 5 categories and those that fall under the 5th category (called the ‘Category E’) are high-cost drugs. These drugs are the ones that require either pharmacoeconomics, HTA or budget impact analysis projected at least for 5 years with a government perspective. The process followed both in Thailand and Vietnam is the same; however, what is required is a strong chair of the committee for essential medicines.

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HSPI also showed their interest in developing policy briefs for their completed project. Policy briefs are summaries of a particular issue presented in a simple format for policymakers and other stakeholders to use. Policy briefs play an integral role in influencing a policy decision. HSPI had 14 medicines and 3 interventions assessed in the past year in collaboration with HITAP and it was now time to send the results and outcomes for policy recommendation.

I got to learn a lot about three things while discussions on these potential topics were on-going. Firstly, I got to know the uniqueness of the Vietnamese Health System and how they are trying to incorporate HTA and pharmacoeconomics in their current system, secondly I learned a lot more about the Thai Health System and how beautifully pharmacoeconomics and HTA has been established to act as a filter at the entry points to assure access to quality health technologies at affordable price and thirdly it made me reflect and realize on the characteristics of the Bhutanese Health System as I was comparing in my mind, the differences in the systems and procedures of these three countries.

samesame but different

 

Acknowledgement:

  1. International Decision Support Initiative (IDSI) for the funding support
  2. Alia Luz for reviewing this blog

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