RESUMO
The Brazilian Ministry of Health has institutionalized two articulated processes in the field of health technology management: (i) the production, systematization and dissemination of health technology assessment, and (ii) the adoption of a flow for the incorporation, exclusion or alteration of new technologies by the Brazilian National Health System. Several advances have been made, such as standardization of methods; production and promotion of studies; institutional development and international cooperation in the area of health technology assessment; definition of the necessary requirements for the presentation of proposals; definition of deadlines; and expansion of the segments that compose the committee that is responsible for the analysis and recommendation. However, some difficulties remain: health technology assessment activities concentrated in the Ministry; low sustainability of the activities of production and dissemination of the assessments; low penetration of health technology assessment in health care institutions; activities of assessment/incorporation with low participation of users; non-transparent decision-making processes; and low integration of the health policy with the scientific and technological policy.
Assuntos
Pesquisa Biomédica/organização & administração , Tecnologia Biomédica/organização & administração , Atenção à Saúde/organização & administração , Planejamento em Saúde/organização & administração , Política de Saúde , Brasil , Difusão de Inovações , Promoção da Saúde , Pesquisa sobre Serviços de Saúde , Humanos , Inovação OrganizacionalRESUMO
O Ministério da Saúde instituiu dois processos articulados no campo da gestão de tecnologias em saúde: (i) produção, sistematização e difusão de estudos de avaliação de tecnologias em saúde e (ii) adoção de um fluxo para incorporação, exclusão ou alteração de novas tecnologias pelo Sistema Único de Saúde. O artigo analisa a experiência brasileira na gestão de tecnologias sanitárias no âmbito do Sistema Único de Saúde, seus principais avanços e desafios. Dentre os avanços obtidos estão: padronização de métodos; produção e fomento de estudos; desenvolvimento institucional e cooperação internacional na área de avaliação de tecnologias em saúde; definição dos requisitos necessários para apresentação de propostas; definição de prazos; e ampliação dos segmentos que compõem o colegiado responsável pela análise e recomendação. Entretanto, algumas dificuldades permanecem: atividades de avaliação de tecnologias em saúde concentradas no Ministério; baixa sustentabilidade das atividades de produção e disseminação das avaliações; baixa penetração da avaliação de tecnologias em saúde nos estabelecimentos de saúde; atividades de avaliação/incorporação com baixa participação dos usuários; processos decisórios pouco transparentes; e baixa integração da política de saúde com a política cientifica e tecnológica.
The Brazilian Ministry of Health has institutionalized two articulated processes in the field of health technology management: (i) the production, systematization and dissemination of health technology assessment, and (ii) the adoption of a flow for the incorporation, exclusion or alteration of new technologies by the Brazilian National Health System. Several advances have been made, such as standardization of methods; production and promotion of studies; institutional development and international cooperation in the area of health technology assessment; definition of the necessary requirements for the presentation of proposals; definition of deadlines; and expansion of the segments that compose the committee that is responsible for the analysis and recommendation. However, some difficulties remain: health technology assessment activities concentrated in the Ministry; low sustainability of the activities of production and dissemination of the assessments; low penetration of health technology assessment in health care institutions; activities of assessment/incorporation with low participation of users; non-transparent decision-making processes; and low integration of the health policy with the scientific and technological policy.
El Ministerio de la Salud de Brasil instituyó dos procesos articulados en el campo de la gestión de tecnologías en salud: (i) producción, sistematización y difusión de estudios de evaluación de tecnologías en salud y (ii) adopción de un flujo para incorporación, exclusión o alteración de nuevas tecnologías por el Sistema Único de Salud. El artículo analiza la experiencia brasileña en la gestión de tecnologías sanitarias en el ámbito del Sistema Único de Salud, sus principales avances y desafíos. Entre los avances obtenidos están: estandarización de métodos; producción y fomento de estudios; desarrollo institucional y cooperación internacional en el área de evaluación de tecnologías en salud; definición de requisitos necesarios para presentación de propuestas; definición de plazos; y ampliación de los segmentos que componen el colegiado responsable por el análisis y recomendación. Mientras, algunas dificultades permanecen: actividades de evaluación de tecnologías en salud concentradas en el Ministerio; baja sustentabilidad de las actividades de producción y diseminación de las evaluaciones, baja penetración de la evaluación de tecnologías en salud en los establecimientos de salud; actividades de evaluación/incorporación con baja participación de los usuarios; procesos decisivos poco transparentes; y baja integración de la política de salud con la política científica y tecnológica.
Assuntos
Humanos , Pesquisa Biomédica/organização & administração , Tecnologia Biomédica/organização & administração , Atenção à Saúde/organização & administração , Planejamento em Saúde/organização & administração , Política de Saúde , Pesquisa Científica e Desenvolvimento Tecnológico , Brasil , Difusão de Inovações , Promoção da Saúde , Pesquisa sobre Serviços de Saúde , Inovação Organizacional , Avaliação da Tecnologia BiomédicaRESUMO
BACKGROUND: The development of products and services for health care systems is one of the most important phenomena to have occurred in the field of health care over the last 50 years. It generates significant commercial, medical and social results. Although much has been done to understand how health technologies are adopted and regulated in developed countries, little attention has been paid to the situation in low- and middle-income countries (LMICs). Here we examine the institutional environment in which decisions are made regarding the adoption of expensive medical devices into the Brazilian health care system. METHODS: We used a case study strategy to address our research question. The empirical work relied on in-depth interviews (N = 16) with representatives of a wide range of actors and stakeholders that participate in the process of diffusion of CT (computerized tomography) scanners in Brazil, including manufacturers, health care organizations, medical specialty societies, health insurance companies, regulatory agencies and the Ministry of Health. RESULTS: The adoption of CT scanners is not determined by health policy makers or third-party payers of public and private sectors. Instead, decisions are primarily made by administrators of individual hospitals and clinics, strongly influenced by both physicians and sales representatives of the medical industry who act as change agents. Because this process is not properly regulated by public authorities, health care organizations are free to decide whether, when and how they will adopt a particular technology. CONCLUSIONS: Our study identifies problems in how health care systems in LMICs adopt new, expensive medical technologies, and suggests that a set of innovative approaches and policy instruments are needed in order to balance the institutional and professional desire to practise a modern and expensive medicine in a context of health inequalities and basic health needs.