A SWOT analysis of the complex interdependencies of the Maltese reimbursement processes
Background: The processes that operationalize the evaluation framework for new medicines are implemented to reach the system objectives of public health, financial sustainability, and equitability. However, when the activities and procedures of these processes are misaligned, the objectives of the s...
| Main Authors: | , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2023-12-01
|
| Series: | Health Policy Open |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2590229623000072 |
| _version_ | 1797796155281637376 |
|---|---|
| author | Katharina Abraham Margreet Franken |
| author_facet | Katharina Abraham Margreet Franken |
| author_sort | Katharina Abraham |
| collection | DOAJ |
| description | Background: The processes that operationalize the evaluation framework for new medicines are implemented to reach the system objectives of public health, financial sustainability, and equitability. However, when the activities and procedures of these processes are misaligned, the objectives of the system may be at risk. Objectives: To evaluate the supporting processes for introducing new medicines in public healthcare services in Malta. Methods: We first reviewed literature on the Maltese reimbursement system and subsequently conducted semi-structured interviews based on the Hutton Framework. Interviewees included policy makers, committee members, procurement staff, medical specialists, pharmacists, and pharmaceutical industry representatives. After validation, we analysed the data with a Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis. Results: Most medicines are assessed for introduction on the Government Formulary List. Exceptional requests fall outside this policy and pass through the Exceptional Medicinal Treatment route. Efficiency, quality, and transparency are major weaknesses across the supporting processes. Taking up responsibility, however, is considered the most important factor in reaching system objectives. Stakeholders tend to shift responsibilities to other processes, start/stop activities that impact the activities of subsequent processes whilst dismissing any contribution to the weaknesses of the system. Consequently, system objectives cannot be reached in an optimum manner. Conclusions: The Maltese case showed that recommendations for introducing new medicines in the public healthcare setting are influenced beyond the choice of HTA tools and criteria. Earmarked budgets, political steering, delays, and uninformed applicants as well as HTA capacity are impeding on system goals of public health, equity, and sustainability. |
| first_indexed | 2024-03-13T03:28:49Z |
| format | Article |
| id | doaj.art-dd75145dcd104bceadbe6d9a0daf6aef |
| institution | Directory Open Access Journal |
| issn | 2590-2296 |
| language | English |
| last_indexed | 2024-03-13T03:28:49Z |
| publishDate | 2023-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Health Policy Open |
| spelling | doaj.art-dd75145dcd104bceadbe6d9a0daf6aef2023-06-25T04:43:34ZengElsevierHealth Policy Open2590-22962023-12-014100095A SWOT analysis of the complex interdependencies of the Maltese reimbursement processesKatharina Abraham0Margreet Franken1Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands; Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, the Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the NetherlandsCorresponding author at: Institute for Medical Technology Assessment, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3062 PA Rotterdam, The Netherlands.; Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands; Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, the Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the NetherlandsBackground: The processes that operationalize the evaluation framework for new medicines are implemented to reach the system objectives of public health, financial sustainability, and equitability. However, when the activities and procedures of these processes are misaligned, the objectives of the system may be at risk. Objectives: To evaluate the supporting processes for introducing new medicines in public healthcare services in Malta. Methods: We first reviewed literature on the Maltese reimbursement system and subsequently conducted semi-structured interviews based on the Hutton Framework. Interviewees included policy makers, committee members, procurement staff, medical specialists, pharmacists, and pharmaceutical industry representatives. After validation, we analysed the data with a Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis. Results: Most medicines are assessed for introduction on the Government Formulary List. Exceptional requests fall outside this policy and pass through the Exceptional Medicinal Treatment route. Efficiency, quality, and transparency are major weaknesses across the supporting processes. Taking up responsibility, however, is considered the most important factor in reaching system objectives. Stakeholders tend to shift responsibilities to other processes, start/stop activities that impact the activities of subsequent processes whilst dismissing any contribution to the weaknesses of the system. Consequently, system objectives cannot be reached in an optimum manner. Conclusions: The Maltese case showed that recommendations for introducing new medicines in the public healthcare setting are influenced beyond the choice of HTA tools and criteria. Earmarked budgets, political steering, delays, and uninformed applicants as well as HTA capacity are impeding on system goals of public health, equity, and sustainability.http://www.sciencedirect.com/science/article/pii/S2590229623000072 |
| spellingShingle | Katharina Abraham Margreet Franken A SWOT analysis of the complex interdependencies of the Maltese reimbursement processes Health Policy Open |
| title | A SWOT analysis of the complex interdependencies of the Maltese reimbursement processes |
| title_full | A SWOT analysis of the complex interdependencies of the Maltese reimbursement processes |
| title_fullStr | A SWOT analysis of the complex interdependencies of the Maltese reimbursement processes |
| title_full_unstemmed | A SWOT analysis of the complex interdependencies of the Maltese reimbursement processes |
| title_short | A SWOT analysis of the complex interdependencies of the Maltese reimbursement processes |
| title_sort | swot analysis of the complex interdependencies of the maltese reimbursement processes |
| url | http://www.sciencedirect.com/science/article/pii/S2590229623000072 |
| work_keys_str_mv | AT katharinaabraham aswotanalysisofthecomplexinterdependenciesofthemaltesereimbursementprocesses AT margreetfranken aswotanalysisofthecomplexinterdependenciesofthemaltesereimbursementprocesses AT katharinaabraham swotanalysisofthecomplexinterdependenciesofthemaltesereimbursementprocesses AT margreetfranken swotanalysisofthecomplexinterdependenciesofthemaltesereimbursementprocesses |