Affordable health technology assessment in Taiwan: A model for middle-income countries

By Wen-Ta Chiu, M.D., Ph.D., Taiwan Minister of Health and Welfare

By launching the National Health Insurance (NHI) programme in 1995, Taiwan has realized the goal of providing universal health care for 99.9% of the population, including prison inmates. The NHI gives patients access to health care ranging from Western drugs and procedures to traditional Chinese medicine. The initiative was ahead of its time, having been implemented long before the 2005 World Health Assembly resolution WHA58.33 which urged states to develop health financing systems as part of efforts to provide universal health coverage.

Among other things, WHA58.33 calls for universal health care systems to provide equal access to health resources. Treatment must be affordable to all, and this puts pressure on health care systems to control costs. Taiwan began conducting health technology assessments (HTA) to determine the suitability of new drugs within the financial context of the NHI system in 2007. HTAs were extended to medical devices in 2011 and to medical services this year.The assessments are utilized to support NHI Administration (NHIA) reimbursement decisions.

After studying HTA agencies in Australia, Canada and the UK, Taiwan’s Ministry of Health and Welfare established the National Institute of Health Technology Assessment (NIHTA), an independent medical nonprofit organization that conducts HTAs free from the influence of governmental agencies and manufacturers.

From 2007 to 2013, HTA working groups and the NIHTA helped the NHIA assess 204 new drugs, 38 breakthrough drugs, and eight medical devices, as well as provided 108 consultations to manufacturers.

The NIHTA actively participates in global and regional organizations in order to promote institutional development and exchange experiences. For example, the institute was one of the founding members of HTAsiaLink, a network established in 2011 to support collaboration between HTA agencies in Asia. Today, the NIHTA is also a member of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) and Health Technology Assessment international. The institute was instrumental in bringing the ISPOR Asia-Pacific Conference to Taipei in 2012 and the upcoming 2015 HTAsiaLink annual conference to Taiwan.

Taiwan’s HTA experience has shown that outstanding results can be produced on a limited annual budget that is significantly lower than those found in many Western countries. For middle-income countries seeking to build an HTA framework, Taiwan’s NIHTA serves as a good model.

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