Page 26 - Htain Manual

H
ealth policy decisions are becoming increasingly important as the

opportunity costs of making wrong decisions continue to grow, especially

in countries where health sector is underfunded. A finite health budget

means that policy makers are faced with difficult decisions regarding choice of technology
and prioritisation of health services on a daily basis.

For example should government introduce a new point of care diagnostic for a fever

or measuring anaemia, which would cost higher per test, but is more specific or accurate. Is

the increase in accuracy and ease of diagnosis worth the much higher spend that government
would have to undertake. Or for cataract surgery should the insurance scheme reimburse for

extra capsular surgery or only for cryosurgery or both, though there is a wide degree in costs

between the two procedures?

Another set of questions relates to programme design. For example, should
government limit screening for oral cancers or hypertension to only those who come to a

health facility, or should there be an effort to actively screen everyone in the population.

Should periodic screening for breast cancer be offered annually to all above 30 or is it better
to offer once in three years to those above 45 years only.

At a more complex level, when government plays the role of strategic purchaser of

healthcare, policy-makers would be confronted with many decisions of which health

condition and population are be prioritised for purchase and why. For example, the
government may be sanctioned some additional resources and have to decide whether to

spend it on reimbursement of those being treated with renal dialysis in elderly with chronic

renal illness or for treating children with leukemia or for diagnosing and treating patients

chronic hepatitis? One woman with breast cancer may be treated with chemotherapy for the

same cost as treating 20 lakh children for intestinal worms.

Health Technology Assessment (HTA) offers scientific solutions to such complex

problems and assists policy makers in taking transparent and prudent decisions. In order to

solve such issues in a judicious manner, HTA is a widely used methodology internationally for

optimization of resource allocation in health. Employing a scientific and evidence based
methodology, HTA assists in judicious choice of technology and programme design and in the

financial allocations so that maximum people can have access to quality healthcare at

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