Decision making criteria

The NHC’s role is to provide New Zealand with a more organised, consistent and transparent national approach to the prioritisation, introduction and expansion of health technology and services in order to improve cost effectiveness and affordability.  This includes the provision of advice on the retention of lower quality interventions that have low cost effectiveness.  The intention is to achieve the following high level outcomes within available and sustainable funding:

• Improved health and independence outcomes for New Zealanders;
• Reduced disparities in health and independence outcomes by addressing priority health needs first;
• Improved clinical and financial sustainability for the public health system.

Key principles to be used to guide the prioritisation between work programme proposals, the development of assessment projects, the use of decision-making criteria and the development of recommendations are:

• Be driven by future population health and independence needs, be informed by long-term changes in the likely patterns and geographic distribution of need and based on realistic long-term revenue assumptions;
• Support changes in the way health and disability care is provided in order to support high quality delivery and to ensure that New Zealanders’ health and disability needs are met in a way that can be practically implemented and is clinically, financially and organisationally sustainable over the longer term;
• Prioritise technology development and models of care to make the most of resources (eg, capital, workforce and Information Technology) and to decrease duplication and increase success-levels.

To be effective, NHC assessments will need to be broad ranging, systematic, structured, evidence-based, transparent, unbiased and robust.  They will need to be conducted within the context of the New Zealand health and disability system and the issues and constraints it faces.  As has been discussed before, to ensure this the Committee is adopting a framework of five assessment domains in order that assessments cover the range of potential considerations and so that the recommendations made are reasonable.  These domains are:

• Clinical
• Societal
• Ethical
• Economic
• Financial.

It is intended that the research questions asked will fall across these domains to ensure that when the Committee comes to apply its decision-making criteria, it has a balanced range of information available to it.  When we are setting those questions we will have the decision-making criteria in mind.
The 11 decision-making criteria outlined below will assist in the determination of the NHC work programme and in the appraisal and prioritisation of assessments.  The criteria proposed are:

• Clinical Safety and Effectiveness
• Health and Independence Gain
• Materiality
• Feasibility
• Policy Congruence
• Equity
• Acceptability
• Cost Effectiveness (Value for Money)
• Affordability
• Risk
• Other Criteria as the NHC thinks fit.

Clinical Safety and Effectiveness

Definition:
Has the technology or service proposed been proved safe, has proven clinical efficacy and can be effectively provided within the context of the New Zealand health and disability environment?

Illustration:
In consideration of the work programme, proposals must have an acceptable level of proven safety and efficacy to be selected for assessment.  The evidence in relation to effectiveness will be a key hurdle for any proposal.  In relation to assessments, proven effectiveness and safety is fundamental.

Health and Independence Gain

Definition:
Will it result in an overall significant net benefit to patients, consumers, whanau, carers, providers, funders and population groups and improved health and independence outcomes for New Zealanders?

Illustration:
In consideration of the work programme this includes ensuring adequate coverage over a range of health and disability conditions and the spectrum of the treatment continuum.  In relation to assessments it will require an understanding of the specific benefits that will be delivered at different levels, eg, individual, clinical, organisational, population group and at the system level.

Materiality

Definition:
Will it make a material and significant difference in the outcomes it delivers, eg, analytically, clinically, socially, economically and financially?

Illustration:
With regards to prioritising the work programme stakeholders will have a view on the materiality of proposals, in terms of their relevance to the sector’s work.  During assessments it will inform decisions on the required level of analysis to support robust recommendations.

Feasibility

Definition:
Is it practical, implementable and sustainable, in terms of both processes and outcomes?

Illustration:
In consideration of the work programme it includes whether the NHC has the ability to undertake a specific assessment, eg, access to the required resources and expertise to enable the assessment to be undertaken in a reasonable period of time.  In relation to assessments it includes whether the proposed implementation is realistically achievable within the constraints existing within the health and disability sector.  In both cases it also includes whether the level of evidence available is sufficient to enable an assessment to be undertaken and for robust recommendations to be made.

Policy Congruence

Definition:
Is the proposal in congruence with current Government and health and disability sector policies, strategies and priorities?

Illustration:
In consideration of the work programme this includes alignment with sector priority areas and also ensuring coverage across the scope of the NHC’s mandate, eg:

• New technologies, interventions, services, programmes and models of care
• Significant service expansions
• Services and interventions that may be of lower value and effectiveness and are, therefore, potential candidates for targeting, reduction or disinvestment.

In relation to assessment and recommendations it includes congruence with existing system frameworks and policies and longer-term policy planning and strategic directions.

Equity

Definition:
Is the proposal fair and does it ensure equity of access and outcomes to different population groups on the basis of need and ability to benefit?

Illustration:
This includes consideration of both horizontal equity (equal treatment for equals) and vertical equity (preferential treatment for unequals) issues.  It requires a consideration of both existing and potential disparities in health in relation to the proposal.

Acceptability

Definition:
Are there any significant ethical, legal, social, or political issues or consumer and stakeholder concerns?

Illustration:
In consideration of the work programme this includes whether sector stakeholders will generally agree that, on balance, the range of assessments chosen is reasonable given assessment capacity.  During assessments, determination of acceptability will require iterative engagement with relevant stakeholders.

Cost Effectiveness (Value for Money)

Definition:
Are the overall costs of the proposal justified by the aggregate benefits that it would generate and is it the most cost efficient way of generating the anticipated benefits?

Illustration:
In the determination of the work programme this will include whether the work programme mix will maximise value to the sector within resource constraints.  Cost effectiveness information will be used to help determine the relative priority of different proposals and recommendations around the relative priority between completed assessments.

Affordability

Definition:
Are the implementation and ongoing costs of the proposal affordable in the short, medium and longer term?

Illustration:
In consideration of the work programme, affordability relates to the budget available for the resources required to complete all the components of assessments.  In relation to assessments, affordability relates to both set-up and operating costs, including any flow-on costs to other areas, and on longer-term sustainability.

Risk

Definition:
Have risks been adequately identified and assessed, and are there mechanisms to ensure that they are effectively managed?

Illustration:
In the consideration of the work programme it includes risks associated with not undertaking an assessment as well as potential project risks.  For assessments it includes an understanding of implementation process risks as well as analysis of the future risks to achieving outcomes, eg, three, five and ten years out. 

Other Criteria as the NHC thinks fit

Definition:
Are there any other significant considerations that are not covered in the specified criteria that would influence the recommendation?

Illustration:
There may be times when additional factors not covered in the other criteria are relevant and need to be taken into consideration towards making recommendations.  When any additional criteria are used the recommendation will need to clearly state the reasons and how they were applied.