Testing and implementing self-management programs: new approaches needed in Health Technology Assessment and Health Policy

Promising Health Care Technologies, of which self-management programs are excellent examples, require new approaches, tools and foremost: attitudes in health practice, in health care research and in health policy.

19. September 2019 | by Dr Bert Boer | Professor Emeritus in Health Coverage Policy, Erasmus University, Rotterdam

Self-management programs and tools put our traditional way of evaluation and decision-making to a challenge. The traditional research and policy models usually use the example of relatively straightforward interventions, like drugs, to illustrate the importance and practice of what they do. But how must new research techniques look like to meet current challenges?

Old school HTA models offer a simple match of evaluation and decision-making. During the last two decades, however, it appeared that one size doesn’t fit all; usual techniques in research and policy don’t fit anything at all. The HTA (health technology assessment) community encounters all sort of problems due to all sort of complexities and reacted on those challenges inventively, by developing and testing new research techniques and new modes of interaction with policy and practice. How do these challenges look like? And how did researchers and policy makers react? The key word is: interaction. And interaction is easier said than done. It requires a new attitude of all parties in the Health Care arena.

It starts with attitudes, and the only one who can do this is: me. For anyone counts: it starts with me.

Reality puts the rational model of Health Technology Assessment to a challenge

For those interested in policy science: HTA (Health Technology Assessment) once was a typical example of the rational policy model. You start with formulating decision criteria for coverage decisions (like safety, effectiveness, cost-effectiveness); you perform some dedicated research (assessments of the technology) to answer the questions raised by your criteria, and you end up with clear-cut yes-or-no decisions, totally guided by the results of your assessment. However, reality puts the rational model to a challenge, in every aspect. To mention some interesting problems: how do we define which sort of effects are essential to patients, to doctors, to the community (which pays for it)? What to choose in case of divergence? Is there a universal, generally accepted measure and threshold for quality of life aspects? What about cost: what types of cost are to be reckoned with and is there a maximum for cost? May be… also a minimum, are certain technologies too cheap to cover, or do they really meet the definition of health care? How do we involve all relevant parties in the arena, to start with patients, but also industry, taxpayers, health care professionals; and how do we integrate the different perspectives and interests of all those involved? Do we get our study results in due time? What to do if not: conditional reimbursement? And finally: how to evaluate complex, composed programs and how do we account for quick developments in the technology itself, and in the way professionals and patients behave and learn? Can we really ascribe effects to specific elements of the program (devices, communication, user capacities)?

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Dr Bert Boer

Dr Bert Boer is a Professor Emeritus in Policy and Research for Health Care Coverage, Erasmus University, Rotterdam. He investigates and teaches contents, procedures, criteria, policy implications of Health Care coverage decisions. Until 2015 he was Executive Member of the Board of the National Health Care Institute in the Netherlands.

Interactivity requires new attitudes

I have a strong conviction: all parties involved have to look out of their own window (be aware of their specific view on things) into the garden (knowledge, interests, values) of the other ones, ask questions and listen to the answers with an open mind. Interactivity is needed between patients and doctors, professionals and policy makers, researchers and HC providers, patients and taxpayers. Surely, we need new policy instruments and regulations, we need new research techniques, we need new organisational skills of professionals and providers, but all that won’t help if we do not learn, listen, leave our silos and bubbles: it starts with attitudes, and the only one who can do this is: me. For anyone counts: it starts with me.

Therefore, it seems that if we want to take advantage of the potential benefits and advantages of apps for self-management, we need to tailor those apps to the circumstances of the people using them. And there is still much to learn on the specific circumstances in which the self-management apps work best and how to sustain it overtime. COMPAR-EU aims to contribute in this area by performing sub-group analysis on the effectiveness of app-based self-management interventions to help identify precisely those areas of success, contributing to expand them across Europe.