Governance structures and health technology assessment agencies: a comparative approach

Abstract

Health technology assessment (HTA) agencies have spread throughout Europe in the past twenty years. The study examined the governance structures for those agencies comparatively, both through cross-national comparison (it looks in detail at HTA agencies for pharmaceuticals and other health treatments in three major European countries- Britain, France and Germany) and through cross-sectoral comparison, notably with economic regulatory agencies in network industries. It examined nine key institutional aspects of governance: legal definition of an agency’s objectives and duties; formal ministerial powers over agency decisions; the appointment of agency members; agency budgets and staff; procedures for experts; decision-making procedures concerning transparency and participation; mechanisms to seek accountability and scrutiny; appeal and legal challenge mechanisms against agency decisions; European networks of regulatory agencies. It found that although there are important differences between network industries and healthcare, comparison of HTA agencies with those regulating network industries in Britain, France and Italy, a European ‘model’ or common set of institutional features has emerged over the last c20 years for the governance of agencies