Taiwan achieved the goal of providing widespread coverage in health care to start the program of the National Health Insurance (NHI) in 1995. Covering 99.9 percent of the population, including those in prison, the NHI provides access to care ranging from medicines and Western procedures to traditional Chinese medicine. The initiative was at the forefront of their times, while the World Health Assembly (WHA), the body responsible for making decision of the World Health Organization-approved resolution WHA58.33 in 2005, which urges States to develop systems of health financing as part of efforts to provide widespread health coverage.

Among other things, the resolution WHA58.33 urges generalized systems of health care to provide equal access to health resources. Treatments should be accessible to everyone, and that puts pressure on health care systems to control costs. Taiwan began in 2007 to conduct assessments of health technology (HTA) to determine the suitability of new drugs within the financial context of the NHI system. HTAs were expanded to medical devices in 2011 and health services this year. Evaluations are used to support reimbursement decisions of the Administration of the NHI (NHIA).

The process of the development of hypertension in Taiwan can be divided into a preliminary stage and two-stage execution. During the preliminary stage from 1995 to 2007, the Drug Benefit Committee (DBC) evaluated whether new drugs were eligible for reimbursement under the NHI system, but not conducted formal HTA. In the first implementation phase, from 2007 to 2012, the records of assessed DBC drugmakers and reports of the working groups of the HTA operating under the Center for Drug Evaluation.

This analysis, which also includes the study of HTA in Australia, Canada and the UK, paid off during the second stage of implementation. This began in 2013, when the Ministry of Health and Welfare established the National Institute of Technology Assessment of Health (NIHTA), an independent medical nonprofit organization that performs the HTA uninfluenced by government agencies and manufacturers. The most recent development in the second step was the establishment of the Scheme and Pharmaceutical Reimbursement Benefit (PBRS), joint evaluation committee composed of 29 members, including government officials, professionals in health, manufacturers and members of the general public . The PBRS replaces the DBC as the final arbiter of the suitability of a new drug within the NHI system.

The NIHTA has four characteristics. First, the school gives priority to quality, efficiency and user satisfaction. Since the founding of the institute, this approach has gained recognition from manufacturers, medical service providers, the NHIA and the public. Second, the NIHTA maintains its focus on quality, while HTA performs at a relatively low cost. For example, the institute is able to fulfill its mission with a annual budget equivalent to just 20 percent and 4 percent of annual funding from their counterparts in Canada and the UK, respectively.

Third, independence from the influence of the Government and manufacturers this ensures that the opinions NIHTA the NHIA reports. In other words, the decision of the institute about the appropriateness of treatment for reimbursement under the NHI program is based solely on empirical evidence. Fourth, the extensive cooperation between the NHIA NIHTA and has resulted in mutual trust. Although not directly addressed NIHTA the NHIA, recommendations NIHTA reports have become vital reference materials for PBRS decisions on the adequacy of treatment for the NHI system.

From 2007 to 2013, working groups HTAs and NIHTA have helped NHIA in the evaluation of 204 new medicines, 38 advanced medicines and eight medical devices, while 108 have provided consultations for manufacturers. HTAs typically evaluate treatments based on comparative effectiveness, cost efficiency and budget impact. As for the newly added categories of devices and medical services two pilot studies are currently evaluating the robot-assisted surgery and laser treatments for benign prostatic hyperplasia.

In addition to this cooperation between the NHIA, the NIHTA has recently begun working with the Centers for Disease Control and Administration for Health Promotion, which operate under the Ministry of Health and Welfare; as well as the Foundation of Taiwan Blood Services, to carry out assessments of policy.

The NIHTA actively participates in global and regional organizations in order to promote institutional development and exchange experiences. For example, the institute is one of the founding members of HTAsiaLink, a network created 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, English acronym), and Health Technology Assessment International. The institution played a key role in the realization of the ISPOR Conference of Asia Pacific 2012 in Taipei, and the upcoming 2015 annual conference HTAsiaLink in Taiwan.

The experience of HTA in Taiwan has shown that you can achieve outstanding results with an annual budget which is significantly lower than those of many Western countries. For middle-income countries seeking to develop an outline of hypertension, NIHTA Taiwan serves as a good model.

traslation: Belén Zapata