Leaving No One Behind: Participatory Technology Appraisal as a Platform for Agenda Setting to Address Disparities in Access to Health Services in Thailand.

OBJECTIVES: This article discusses how participatory technology appraisal as part of the Universal Coverage Scheme (UCS) in Thailand contributes to improving access to essential health services among vulnerable populations. METHODS: Document review was conducted on health technology appraisal approaches introduced by the UCS. The review involves health benefit proposals advanced by stakeholders and also meeting minutes of relevant working groups and committees published between 2010 and 2015. RESULTS: From the establishment of the UCS participatory technology appraisal mechanism in 2010 until 2015, a total of 133 health interventions have been nominated. Some nominations highlight problems in access to care among vulnerable populations. As policy advocates continue to be involved in the latter stages of coverage decisions, they have opportunities to persuade policy makers and other stakeholders to agree to the rationales of their proposals. Some interventions were rejected because they did not meet value for money, affordability, and feasibility criteria; however, topic nominations from stakeholders as well as relevant deliberation throughout the technology appraisal processes have a potential to improve accessibility of health care among the disadvantaged. CONCLUSIONS: Through participation in the UCS policy-making processes, key stakeholders are able to direct the attention of decision makers to significant gaps in access to services among vulnerable citizens, a health system problem rarely brought to discussion by policy elites and experts. The Thai experience reaffirms participatory technology appraisal as a supportive measure to providing universal health coverage.

Health Technology Assessment in Thailand: Institutionalization and Contribution to Healthcare Decision Making: Review of Literature.

OBJECTIVES: To explore health technology assessment (HTA) in Thailand focusing on its institutionalization, key elements for HTA introduction, and HTA contribution to policy. METHODS: A review of literature covered a wide range of topics, including the institutionalization of HTA, elements of HTA introduction, and the role of HTA in policy decision making in Thai context. Additional information from the authors' involvement in the policy decision-making process in Thailand was also considered. RESULTS: HTA institutionalization comprises processes of introducing HTA, including evidence generation and use in policymaking, building capacity of HTA practitioners, organizations, system infrastructure, and collaborations. In Thailand, HTA has been formally integrated into coverage decisions, including in the development of the National List of Essential Medicines and the Universal Health Coverage Scheme benefits package. Contributing factors included political will and leadership, capacity building on HTA-related disciplines, adequate resources, technical expertise, and data. Conversely, challenges faced included the absence of a governing body and strategic plan for HTA systems development, a lack of formal mechanisms for mobilizing financial support, an inadequate number of HTA researchers in nonprofit institutes, and the rise in advanced biotechnologies. CONCLUSIONS: HTA plays an important role in evidence-based healthcare decision making. However, key elements of HTA institutionalization need to be strengthened, especially governance structure and policy for HTA systems development, building and retaining capacity of HTA practitioners to meet demand, addressing the challenges of complex and highly innovative health interventions. Lessons learned from the Thai experience may be used as guidance for HTA institutionalization in other developing countries.