Assessing Health Technology Assessment Agencies in Central and Eastern Europe
"I've been interested in the topic of health care rationing for a long time," explains Olga Löblová (PhD '16). It was that interest that led her to take a closer look at health technology assessment (HTA) agencies. "HTA agencies are public bodies that evaluate available evidence on the medical, economic, ethical, legal, social, and other aspects of health interventions – drugs, medical devices, diagnostic procedures, surgical interventions, etc.," Löblová explains. These are the bodies that are responsible for making the decisions about health care rationing in most of Western Europe. Interestingly though, there are fewer HTA agencies in Central and Eastern Europe than there are in Western Europe. "I was curious to find out why that was," she says.
Löblová explains that international policy diffusion is often portrayed as a "quasi-automatic process in which fashionable policy options spread from one country to another relatively unconstrained." The assumption, she says, is that policy diffusion is a good thing, and so if, for example, a particular country does not have an HTA agency, it must be because it lacks something – perhaps the financial resources or the expertise. "There are so many examples though where it is obvious that this is not the case," she says. Löblová points out that Poland, which has a particularly robust HTA agency, "started small and then grew," so clearly limited financial resources is not an obstacle. She goes on to observe that there are other countries that have not established an HTA agency because it isn't a priority. She quickly adds, "The assumption even in those countries that don't have an HTA agency now is that they will have one eventually."
As Löblová notes, it is policymakers who enact policy. Based on her research, she concluded that although there are epistemic communities of experts in these countries who believe in HTA agencies and push for them, policymakers don't consult them. "It's not that there is strong opposition," she says, "but rather that there is not enthusiastic support." This conclusion surprised her. "I expected to find that there were vested interests in countries that did not have HTA agencies that opposed their establishment and that this was why they did not exist."
Another discovery that surprised Löblová was that there has been very little policy evaluation so far of HTA agencies. She says that one of the reasons for that is the division between the political science and health policy communities. "One is afraid of the other," she says. Löblová's research transcends these two disciplines. "The topic of health care fascinates me," she explains. "It is such an interesting and rich topic. The decisions that countries make about health care reflect its values, its priorities, its history – so many things." It is research that she plans to continue.