INSTITUTIONALIZING HEALTH TECHNOLOGY ASSESSMENT IN REPUBLIC OF MOLDOVA TO ADVANCE EVIDENCE-INFORMED REIMBURSEMENT, MANAGED ENTRY AGREEMENTS, AND FINANCIAL PROTECTION
Author(s)
Elena Chitan, MPH, PharmD1, Iuliana Albu, MEc2, Alexandru Gasnas, PhD Neurology3, Iuliana Garam, MPH, Master of Economy, Finance-baking management4.
1Assistant, Department of Social Pharmacy "Vasile Procopisin", Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Moldova, Republic of, 2Republic of Moldova Agency of Medicine and Medical Devices, Chisinau, Moldova, Republic of, 3Department of Neurology No. 2, „Nicolae Testemitanu” State University of Medicine and Pharmacy, Chisinau, Moldova, Republic of, 4WHO Country Office, Republic of Moldova, Chisinau, Moldova, Republic of.
1Assistant, Department of Social Pharmacy "Vasile Procopisin", Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Moldova, Republic of, 2Republic of Moldova Agency of Medicine and Medical Devices, Chisinau, Moldova, Republic of, 3Department of Neurology No. 2, „Nicolae Testemitanu” State University of Medicine and Pharmacy, Chisinau, Moldova, Republic of, 4WHO Country Office, Republic of Moldova, Chisinau, Moldova, Republic of.
OBJECTIVES: Moldova is institutionalizing health technology assessment (HTA) to address a structural gap in health financing: public reimbursement, centralized procurement and national programme decisions have historically been fragmented and insufficiently linked to comparative clinical value, cost-effectiveness, budget impact and equity. The study aims to assess how the proposed HTA mechanism can support universal health coverage (UHC) and financial protection in a context where WHO financial protection evidence shows that out-of-pocket (OOP) payments continue to undermine UHC, with catastrophic health spending, impoverishing health spending of households at risk of impoverishment, and OOP spending rising.
METHODS: A mixed-methods policy-research design triangulated three evidentiary streams: structured documentary analysis of draft legislation benchmarked against EU 2021/2282 HTA governance models; secondary analysis of WHO financial-protection metrics and the 2019-2023 Moldova Household Budget Survey, and a national stakeholder survey (N=212) assessing institutional readiness.
RESULTS: Catastrophic health spending decrease from 11.7% in 2019 to 9.5% in 2023, while impoverishing health spending remained unchanged (4.4% to 4.2%); 6.1% of households were at risk of impoverishment. OOP spending rose from 1,743 to 2,211 MDL per person, driven by outpatient medicines (44.9% of catastrophic spending; 74% in the poorest quintile), diagnostic tests (16.2%) and medical products. Hardship was regressive: 57.5% of catastrophic spending was concentrated in the poorest quintile, with uninsurance at 16.1% and 21.3% among the poor. Current reimbursement decisions remain disconnected across legal acts and without unified value criteria; economic evaluations use cost-minimization and omit QALYs/ICERs. The proposed HTA pathway separates technical assessment, appraisal, negotiation and decision-making: AMDM is the single entry window, Deliberation Council appraises public value, Inter-institutional Negotiation Council negotiates terms, MoH makes final decisions. A phased implementation strategy was adopted beginning with innovative medicines.
CONCLUSIONS: Institutionalizing HTA as a binding, phased, and transparent health financing mechanism can transforms technical evidence into tangible financial protection and strengthens universal health coverage.
METHODS: A mixed-methods policy-research design triangulated three evidentiary streams: structured documentary analysis of draft legislation benchmarked against EU 2021/2282 HTA governance models; secondary analysis of WHO financial-protection metrics and the 2019-2023 Moldova Household Budget Survey, and a national stakeholder survey (N=212) assessing institutional readiness.
RESULTS: Catastrophic health spending decrease from 11.7% in 2019 to 9.5% in 2023, while impoverishing health spending remained unchanged (4.4% to 4.2%); 6.1% of households were at risk of impoverishment. OOP spending rose from 1,743 to 2,211 MDL per person, driven by outpatient medicines (44.9% of catastrophic spending; 74% in the poorest quintile), diagnostic tests (16.2%) and medical products. Hardship was regressive: 57.5% of catastrophic spending was concentrated in the poorest quintile, with uninsurance at 16.1% and 21.3% among the poor. Current reimbursement decisions remain disconnected across legal acts and without unified value criteria; economic evaluations use cost-minimization and omit QALYs/ICERs. The proposed HTA pathway separates technical assessment, appraisal, negotiation and decision-making: AMDM is the single entry window, Deliberation Council appraises public value, Inter-institutional Negotiation Council negotiates terms, MoH makes final decisions. A phased implementation strategy was adopted beginning with innovative medicines.
CONCLUSIONS: Institutionalizing HTA as a binding, phased, and transparent health financing mechanism can transforms technical evidence into tangible financial protection and strengthens universal health coverage.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HPR146
Topic
Health Policy & Regulatory, Health Service Delivery & Process of Care, Health Technology Assessment
Topic Subcategory
Reimbursement & Access Policy
Disease
No Additional Disease & Conditions/Specialized Treatment Areas