Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 9 9 2020 09 01 Around the Tables – Contextual Factors in Healthcare Coverage Decisions Across Western Europe 390 402 3739 10.15171/ijhpm.2019.145 EN Tineke Kleinhout-Vliek Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands Antoinette De Bont Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands 0000-0002-0745-4537 Meindert Boysen National Institute for Health and Care Excellence (NICE), London, UK Matthias Perleth Federal Joint Committee (Gemeinsamer Bundesausschuss), Berlin, Germany Romke Van Der Veen Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, The Netherlands Jacqueline Zwaap National Health Care Institute (Zorginstituut Nederland), Diemen, The Netherlands Bert Boer Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands Journal Article 2019 10 07 Background Across Western Europe, procedures and formalised criteria for taking decisions on the coverage (inclusion in the benefits basket or equivalent) of healthcare technologies vary substantially. In the decision documents, which display the justification of, the rationale for, these decisions, national healthcare institutes may employ ‘contextual factors,’ defined here as situation-specific considerations. Little is known about how the use of such contextual factors compares across countries. We describe and compare contextual factors as used in coverage decisions generally and 4 decision documents specifically in Belgium, England, Germany, and the Netherlands. Methods Four group interviews with 3 experts from the national healthcare institute of each country, document and web site analysis, and a workshop with 1 to 2 of these experts per country were followed by the examination of the documents of 4 specific decisions taken in each of the 4 countries, sampled to vary widely in type of technology and decision outcome. Results From the available decision documents, we conclude that in every country studied, contextual factors are established ‘around the table,’ ie, in deliberation. All documents examined feature contextual factors, with similar contextual factor patterns leading to similar decisions in different countries. The Dutch decisions employ the widest variety of factors, with the exception of the societal functioning of the patient, which is relatively common in Belgium, England, and Germany. Half of the final decisions were taken in another setting, with the consequence that no documentation was retrievable for 2 decisions. Conclusion First, we conclude that in these countries, contextual factors are actively integrated in the decision document, and that this is achieved in deliberation. Conceptualising contextual factors as both situation-specific and actively-integrated affords insight into practices of contextualisation and provides an encouragement for exchange between decision-makers on more qualitative aspects of decisions. Second, the decisions that lacked a publicly accessible justification of the final decision document raised questions on the decisions’ legitimacy. Further research could address patterning of contextual factors, elucidate why some factors may remain implicit, and how decisions without a publicly available decision document may enable or restrain decision-making practice.

https://www.ijhpm.com/article_3739_fec906e8c293b7b9737037b7063714a3.pdf