In a transformative move to strengthen its healthcare system, Indonesia’s Ministry of Health initiated the Indonesian Health Technology Assessment Committee (InaHTAC) in 2014, aiming to prioritize evidence-based health care technologies within the national insurance scheme. Despite these efforts, the journey toward streamlined health technology access in Indonesia remains fraught with complexities and challenges.
Stakeholder Involvement and Decision-Making
The evaluation and approval of healthcare technologies in Indonesia involve a multifaceted decision-making process that engages numerous stakeholders, each bringing unique perspectives and interests. This multi-stakeholder approach, while advantageous for comprehensive evaluation, often leads to prolonged and intricate licensing processes. Market access is influenced by the diverse roles and interests of these stakeholders, making the harmonization of their inputs essential for efficient technology dissemination.
Efforts to bolster the Health Technology Assessment (HTA) ecosystem have included capacity-building initiatives and the development of detailed guidelines. Despite these measures, several obstacles persist. Key among them are insufficient infrastructure, limited financial and technical resources, and subpar stakeholder engagement, all of which impede timely technology integration into the healthcare system.
Challenges and Political Influences
The current positioning of the HTA unit within the Ministry of Health is another significant hurdle. Political pressures, especially from the pharmaceutical industry, often result in delays or disregard for HTA recommendations. This situation underscores the need for an independent HTA body, free from political influence, to facilitate unbiased and prompt decision-making. Such an independent entity would enhance the market access for new health technologies by ensuring that regulatory processes are transparent and efficient.
To achieve a robust HTA framework, Indonesia must adopt a phased approach, addressing the inadequacies in resources and stakeholder coordination. This will necessitate strong regulatory mechanisms to foster harmonized and cooperative interactions among all involved parties, ultimately leading to improved healthcare outcomes.
Key Inferences
- Effective HTA depends on the seamless integration of diverse stakeholder inputs, which can be challenging but is crucial for balanced decision-making.
- An independent HTA body is essential to mitigate political and industrial pressures, ensuring unbiased health technology evaluations.
- Strengthening infrastructure and resources is critical to enhance the HTA process and facilitate timely market access for new technologies.
In conclusion, while Indonesia has made significant strides in establishing an HTA framework, there remains a pressing need for an independent, well-resourced, and coordinated approach to fully realize the potential of health technology assessments. This will not only streamline the licensing and evaluation processes but also ensure that the most effective healthcare technologies are accessible to patients, ultimately improving the overall health system.
Original Article:
Health Syst Reform. 2023 Dec 31;9(3):2371470. doi: 10.1080/23288604.2024.2371470. Epub 2024 Jul 15.
ABSTRACT
In 2014, Indonesia’s Ministry of Health established the Indonesian Health Technology Assessment Committee (InaHTAC) to prioritize evidence-based health care technology for inclusion in the national health insurance benefits package. This commentary provides an overview of the current state of the health care technology supply landscape in Indonesia, as well as the impact of HTA studies on priority-setting decisions. Indonesia’s decision-making process for health care technology approval and patient access involves multiple stakeholders and follows several evaluation principles. The licensing, inclusion, and evaluation of health care technology is complex and time consuming, however, requiring input from stakeholders with different roles and interests. Although efforts have been made to establish an HTA ecosystem by, for example, engaging in capacity-building activities and issuing guidelines, challenges remain, including a lack of infrastructure, financial resources, and technical capacity and inadequate stakeholder involvement. Additionally, the current position of the HTA unit, which is connected to the Ministry of Health (MOH), and political pressures from the pharmaceutical industry can result in delayed or ignored HTA recommendations. Therefore, the establishment of an independent and robust HTA body that can inform policy makers about health technology development, licensing, dissemination, and use, along with strong regulations to ensure harmonization and coordination among stakeholders, is necessary. This requires a step-by-step approach to address inadequate overall HTA resources.
PMID:39008816 | DOI:10.1080/23288604.2024.2371470
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