EUR-ASSESS PROJECT SUBGROUP REPORT ON COVERAGE

The issue of health benefits coverage-and its relation to health techn ology assessment (HTA)- has gained increasing attention in recent year s. Economic constraints on health care, as well as the rapid pace of t echnological change, have forced European countries to face difficult choices in providing such care. The active use of coverage decision ma king has been proposed as a tool to help rationalize health care, and HTA has been advocated as a necessary activity to improve coverage dec isions. Coverage of health care interventions-called ''benefits'' from the perspective of the members of a health care plan-means that the c osts of these health care interventions are fully or partly financed b y a health care plan. Such a plan may be a national health care system or any social or private health insurance system. Coverage is an impo rtant issue in health care policy. Health care policy today aims at im proving health care quality within a comprehensive and accessible heal th care system while controlling costs. This goal can only be reached if safe and cost-effective interventions are stimulated and the use of inefficient and unsafe interventions is discouraged. One of the means to channel technology in health care is only to cover cost-effective interventions and to exclude others. Preferably, decisions to include an intervention in the benefit package should be based on sound inform ation about needs, effectiveness, safety, and costs. In the United Sta tes, it was found that the largest barrier to decision making for all insurers is ''the paucity of reliable information on the effectiveness , safety, and cost-effectiveness of new technologies at the time cover age decisions have to be made'' (43). The same is undoubtedly true in Europe. Health technology assessment can generate such necessary infor mation. The idea of linking HTA and coverage is spreading. For example , a national commission in the Netherlands (the Dunning Commission) wa s asked by the government for advice on making difficult choices in he alth care (23). The commission acknowledged serious problems of ineffe ctive and cost-ineffective technologies and overuse of effective techn ologies in the Dutch health care system. It proposed, as part of healt h care reforms, that a basic benefit package for the population be def ined using formal studies of effectiveness and cost-effectiveness. Sim ilar developments are under way in a number of countries. The situatio n is changing rapidly in such countries as the Netherlands, France, an d Spain (particularly Catalonia). Other European countries are conside ring more explicit coverage policies and their links to HTA. The goal of this report is to compare the content and process of decision makin g on coverage in a number of European countries. The hypothesis was th at HTA does exert some degree of influence on coverage, but that there are significant differences among the countries of the European Union . The subgroup also aimed to suggest changes for the future to bring c overage and HTA closer together.