People often considered it self-evident that everyone has access to healthcare. But, as a society, there are limits on that we can and want to pay for our health. In order to define what should be included in the benefit package, we need to systematically assess social values, says Rob Baltussen, professor of Global Health Economics at Radboudumc on 17 June in The Lancet. The methodology of Health Technology Assessment (HTA) is now widely used to support decisions on benefit package design. Yet, a problem with HTA is that decisions are often taken based on evidence of safety, effectiveness and cost of treatment, whereas broader social and ethical values, such as the impact of a disease on caregivers, are not systematically examined. These are much more difficult to measure, but not less important. Rob Baltussen: "We now see that ethical criteria are insufficiently taking into account". Baltussen proposes the use of multi criteria decision analysis in combination with ethical frameworks to improve on this.
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