英国NICE卫生技术评估公众参与机制及启示

Mechanism and enlightenment of public participation in the NICE health technology assessment in England

目的深入剖析英国国家卫生与服务优化研究院(NICE)卫生技术评估公众参与机制,以期为我国医保目录动态调整工作提供经验借鉴。方法检索相关文献及官方网站,对英国NICE卫生技术评估公众参与类型、参与机制(管理机构、遴选方式、参与模式、评估反馈)进行分析,并据此提出对我国医保目录调整公众参与的建议。结果与结论当前NICE卫生技术评估公众参与类型主要涉及患者及照护者组织、评估委员会非专业成员、患者专家、公众观察员4类。在管理层面,NICE设立了公众参与团队并制定了有关公众参与事项的指南;针对不同类型公众,NICE确定了兴趣表达、NICE邀请、公开招聘、提名、NICE决定等不同的遴选程序;公众参与的类型多样,且从卫生技术评估最初的主题范围确定到最终的上诉,全程均有公众的参与;建立了灵活动态的评估反馈体系以优化公众参与的方式和卫生技术评估流程;开展了广泛的国际合作与交流以促进国家和国际层面的公众参与。建议我国结合国情,明确公众参与卫生技术评估的渠道,成立公众参与事务工作小组,加强患者参与评估与反馈,提高决策透明度,从渠道开设、管理机制、评估反馈、信息公开等方面不断完善我国卫生技术评估公众参与机制。

OBJECTIVE To analyze the public participation mechanism of National Institute for Health and Care Excellence(NICE)health technology assessment in England and to provide experience for the dynamic adjustment of Chinese medical insurance catalog.METHODS By retrieving related literature and official websites,types and mechanisms of public participation(management organization,selection method,participation mode,evaluation feedback)in NICE health technology assessment were analyzed comprehensively;and based on this,suggestions were put forward to adjust the public participation in Chinese medical insurance catalog.RESULTS&CONCLUSIONS The current public participation types of NICE health technology assessment were patient and carer organizations,HTA committee lay members,patient expert and public observers.At the management level,NICE has set up a public participation team and made guidelines on public participation matters.For different public participation types,NICE has established different selection procedures,such as expression of interest,NICE invitation,open recruitment,nomination,NICE decision,etc.The public participation types are various and in the whole assessing process from the initial determination of the scope of the health technology assessment to the final appeal.Also,NICE has established a flexible and dynamic evaluation feedback system to optimize the way of public participation and the health technology assessment process;NICE has undertaken extensive international cooperation and exchanges to promote public participation at the national and international levels.It is suggested that our country should combine the national conditions,clarify the channel of public participation in health technology evaluation,set up a working group of public participation affairs,strengthen patients’participation in evaluation and feedback,improve decision-making transparency,and improve the public participation mechanism of health technology evaluation from the aspects of channel opening,management mechanism,evaluation feedback,information disclosure and so on.