Study on the evidence-based decision-making framework for reimbursement technologies in view of EVIDEM / 中国卫生政策研究

ABSTRACT

This study aimed to establish a new technology for health insurance reimbursement evidence-based decision-making framework on the basis of EVIDEM. Literature review,focus group discussion and qualitative inter-view were used to construct the preliminary decision-making framework,and expert consultation was adopted to deter-mine the necessity and weight of the criteria. The established evidence-based decision-making framework consists of guidelines of normative universal and contextual aspects. The normative aspect included following criteria, need for intervention (i.e. disease severity, size of affected population, benefit type of technology, unmet needs of reim-bursed technology),comparative outcomes of technology (i.e. comparative effectiveness,comparative safety/tolera-bility,comparative patient-perceived/patient-reported outcomes), and economic consequences of technology (i.e. cost,results of economic evaluation). The contextual aspect reflects the mission and mandate of medical insurance, population priorities and the accessibility,common goal and specific interests, political context, and affordability of medical insurance.