The Hutton framework is a descriptive framework to detail and classify reimbursement systems. Within this framework, two levels can be defined. The first level is the policy implementation level. The main elements of this level are establishment, objectives, implementation and accountability (Hutton et al. 2006). These elements describe how the reimbursement system ‘is embedded in the broader political system’ (Franken et al. 2012). In the element establishment, the relationship of the national health authority to the ministry of health will be explored, as well as the involvement of other organizations to the reimbursement process. The element objectives is about broader political, social and health system objectives, like cost control and quality of care (Hutton et al. 2006). Within the policy implementation level, it will also be defined how reimbursement policies are implemented. This can be done directly by the ministry of health or it can be done independent of the ministry. Also for the implementation, it is important to consider whether other organizations are involved in the implementation process (Hutton et al. 2006). The last element of the policy implementation level is about managerial, legal and political accountability (Hutton et al. 2006).
Where the policy implementation level is about the reimbursement policy of a country, the technology decision level is about the process of individual reimbursement requests. This process can be divided into three phases; assessment, decision making and the outputs and their implementations (Hutton et al. 2006). Each phase can be grouped into four areas, which are constitution and governance, methods and processes, use of evidence and accountability and transparency (Hutton et al. 2006).
In the assessment phase, it can be compared how different countries or institutions consult and involve different stakeholders and the assessment ‘links the roles of the stakeholders with the methodology of assessment and the way in which evidence is sourced and used’ (Hutton et al. 2006). For transparency and accountability in the assessment phase, it is important to examine the presentation and communication of the assessment results.
The decision making phase is about the institution who is making the decision and the methodology that is used to process the decisions (Hutton et al. 2006). Regarding the use of evidence, it is important to examine the additional influences on the decision. Are these influences evidence based? The accountability and transparency of the decision making process is dependent on the communication of the content and documentation of the decision. The communication of the decisions can have an important effect on the acceptance of a new drug or technology (Hutton et al. 2006).
In the outputs and implementation phase, it is important to know what the formal appeal procedure is. Regarding the methods, the implementation and communication of the health care drugs and technologies need to be examined (Hutton et al. 2006). With the use of evidence in the output and implementation phase, the monitoring and reappraisal process will be explored. Finally, it is important to examine whether the impact of the decision is monitored and whether monitoring will lead to further action (Hutton et al. 2006).
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