Making Sensible Rationing: The Use of Economic Evidence and the Need for Methodological Standards

Viroj Tangcharoensathien MD, PhD*, Pirom Kamolratanakul MD, MSc**

Affiliation : * International Public Policy Program, Ministry of Public Health, Nonthaburi ** Faculty of Medicine, Chulalongkorn University, Bangkok

Thailand was increasingly facing budget constraints when a comprehensive package of services was provided literally free to the whole population; therefore rationing is inevitable. ‘Good value for money’ is among the popular criteria in priority setting as it offers a sensible basis to compare marginal benefits with the resources spent across interventions. The majority of cost-outcome studies in Thailand were subject to bias as they relied on low-quality evidence. The methods applied also varied greatly. This hampers comparisons across studies. The first ever national guideline was developed by experts from different institutes to propose the most practical ways of conducting health technology assessment on the basis of economic principles in the Thai context. This paper also draws lessons from a transparent process involving key stakeholders in select- ing technologies to be assessed given time and resources constraints. Finally, it is hoped that these tools and methods will be applicable for Thailand to facilitate comparisons of different studies in order to better inform policy decisions in a transparent manner.

Keywords : Rationing, Economic evaluation, Guidelines, Health technology assessment

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