Capacity Building for Health Technology Assessment in Jordan: Institutionalization and Its Use in Pricing and Reimbursement Decisions.

OBJECTIVES: This study aimed to describe the process of the institutionalization of health technology assessment (HTA) in Jordan. In particular, this study presents local policy perspectives on capacity building for HTA and the progress made toward its use in pricing and reimbursement decisions. HTA CAPACITY BUILDING: University-based education and professional development training in pharmacoeconomics and pharmaceutical policy have been the starting points to create a receptive environment, necessary expertise, and local tools across many settings in Jordan. International collaboration with HTA supporting bodies helped to build connections and informed policy development on local levels through projects, meetings, and discussions. HTA INSTITUTIONALIZATION AND ITS USE IN PRICING AND REIMBURSEMENT DECISIONS: Institutionalizing HTA in the King Hussein Cancer Center and the Royal Medical Services was the driving factor for HTA implementation and practice advancement; nevertheless, process transparency and experience sharing through reports and publications are still limited. The Jordan Food and Drug Administration's pricing and formulary decisions require pharmacoeconomic consultation in selected cases according to the Jordanian Drug Law. Nevertheless, there is a lack of local methodological guidelines for conducting HTA. In addition, HTA practitioners and the regulatory scope of future HTA activities in Jordan cannot be determined yet. RECOMMENDATIONS AND FUTURE DIRECTIONS: Over the past 2 decades, Jordan has crossed a number of milestones and advanced further to implement HTA as a tool for evaluating health interventions. As a next step, legislation is needed to mandate the use of HTA and to enhance transparency in decision-making processes.

Actuarial cost and fiscal impact of expanding the Jordan Civil Insurance Programme for health coverage to vulnerable citizens.

BACKGROUND: Achieving universal health coverage is a strategic goal for the Government of Jordan. Estimating the cost of expanding health coverage to vulnerable Jordanians under the Civil Insurance Programme (CIP) is an important step towards achieving this goal. AIMS: This study aimed to estimate the cost and fiscal impact of expanding health insurance coverage to vulnerable Jordanians. METHODS: We identified and quantified vulnerable Jordanians and estimated their utilization and cost of health services provided at Ministry of Health facilities using allocation and macrocosting approaches. We calculated the annual actuarial cost per person and the fiscal impact of the expansion. RESULTS: It was estimated that 4.9% of Jordanians were vulnerable. On average, a vulnerable Jordanian used 1.25 ambulatory visits and 0.027 admissions fewer annually than a person insured by CIP. The annual cost (US$ 79 million) and fiscal impact (US$ 73 million) of expanding coverage to vulnerable Jordanians were due to more ambulatory services (20%) and hospitalizations (80%). CONCLUSION: A combination of additional resources and improvement in system efficiencies may fund this expansion.