Integrating Financial Risk Protection into HTA and Coverage Decision-Making: Conceptual Foundations, Emerging Methods, and Evidence
Moderator
Akshar Saxena, PhD, Nanyang Technological University, Singapore, Singapore
Speakers
Nathorn Chaiyakunapruk, PharmD, PhD, University of Utah, Salt Lake City, UT, United States; Min Hu, PhD, Fudan University, Shanghai, China; Boshen Jiao, MPH, PhD, University of Southern California, Los Angeles, CA, United States
Health systems aim not only to improve population health, but also to protect individuals and families from the financial consequences of illness. Financial hardship from out-of-pocket medical spending and income loss remains a major concern globally. As countries pursue universal health coverage and value-based health care, there is growing interest in incorporating financial risk protection (FRP) into health technology assessment (HTA) and coverage decision-making. However, key methodological and policy questions remain unresolved: how should FRP be measured, how should it be considered alongside health outcomes and cost-effectiveness, and what evidence exists on the impact of health interventions and coverage policies on financial protection? This workshop will review conceptual frameworks, emerging methods, and empirical evidence on FRP and discuss implications for HTA and coverage decisions.
Saxena will open the workshop by discussing the policy relevance of FRP and its growing role in HTA and coverage decision-making across health systems. Chaiyakunapruk will present a case study from Thailand’s universal health coverage experience, including chronic kidney disease and the “Peritoneal Dialysis First” policy, to illustrate how FRP evidence can inform HTA and coverage decisions. The case will highlight how coverage policies affect out-of-pocket spending, catastrophic health expenditure, medical impoverishment, and access to care. Hu will present evidence from China on the financial and distributional consequences of alternative health insurance coverage policies for multiple sclerosis, showing how extended cost-effectiveness analysis and microsimulation can jointly evaluate health outcomes, FRP, and equity impacts. Jiao will summarize key methodological developments and introduce emerging approaches for incorporating FRP into economic evaluation and decision-making, including value-of-insurance and multi-objective decision frameworks.
The session will conclude with an interactive discussion and audience Q&A on methodological challenges, implementation considerations, and opportunities for integrating FRP into HTA and coverage decisions internationally.
Topic
Economic Evaluation, Health Technology Assessment, Real World Data & Information Systems