Introduction: Türkiye’s Healthcare Transformation

Over the past two decades, Türkiye has significantly advancements in its healthcare system. With a focus on improving healthcare outcomes, the country has improved in various areas, including the establishment of Health Technology Assessment (HTA) bodies and the introduction of innovative reimbursement models. Despite these improvements, challenges remain, particularly in HTA. This article examines Türkiye’s journey in HTA, highlighting key achievements and future directions.

The Health System in Türkiye

Over the past 20 years, Türkiye has notably improved its population health metrics. Life expectancy has increased from 70 years in 2003 to 79 years in 2022. Universal health coverage now extends to 99% of the population, up from 72% in 2003. However, Türkiye still faces issues related to resource allocation and geographic disparities in healthcare access.

Türkiye’s healthcare system is highly centralised under the Ministry of Health (MoH). Policies are set by the President and implemented by the MoH. The system is predominantly state-funded, with public spending accounting for 78% of total health expenditure. Public spending on healthcare is 4.7% of GDP, significantly lower than the EU average of 10.9%. The Social Security Institution (SSI) determines which services are reimbursed under the universal health insurance scheme.

A Roadmap for New Technologies

HTA plays a crucial role in evaluating new health technologies and ensuring their effective integration into the healthcare system. Türkiye’s HTA agency, established in 2012 and later renamed the Research Development and Health Technology Assessment Department (HTAD), is essential in this process. In Türkiye, a marketing authorisation from the Turkish Medicines and Medical Devices Agency (TİTCK) is mandatory for market entry. The SSI then decides which interventions will be reimbursed, under what conditions, and for how much. The Healthcare Services Pricing Commission (HSPC) evaluates each innovative technology. The Alternative Reimbursement Scheme (ARS), implemented in 2016, allows for innovative reimbursement models, mitigating financial pressures on the pharmaceutical budge.

Current Challenges for HTA in Türkiye

One of the most significant challenges in HTA implementation in Türkiye is the lack of transparency. Although several bodies conduct HTAs, only the MoH publishes national HTA reports. The lack of a transparent topic selection process further complicates matters. There is no legal requirement for the SSI to conduct HTAs before making reimbursement decisions. This lack of incentive hinders comprehensive evaluations of health technologies.

The fragmented structure of HTA bodies and the absence of standardised methodologies further complicate the process. This lack of coordination and standardisation leads to inconsistencies in assessment outcomes. Recently, the Consolidated Health Economic Evaluation Reporting Standards (CHEERs) reporting guidelines for economic evaluation studies were adapted to Turkish, which may help standardise economic evaluations.

Next Steps for HTA in Türkiye

According to Castro et al.’s HTA framework, Türkiye is at the policy formulation stage, with sporadic HTA activities in different organisations. The Smart Life and Health Products and Technologies Roadmap proposes the establishment of a politically independent national HTA institution between 2022 and 2025. This institution would provide objective scientific advice, akin to the UK’s National Institute for Health and Care Excellence (NICE).

Creating national HTA guidelines is crucial for producing consistent and useful HTA evidence. Some experts suggest adopting a cost-effectiveness threshold, but further discussions and empirical research are needed.

The country has emerging capacity in health economics, but training programs for HTA professionals are essential. Collaboration with established HTA agencies could be beneficial for capacity building.

Conclusion

Türkiye is currently at a critical point in time in its HTA development. With the promise of national guidelines, consideration of cost-effectiveness thresholds, and ongoing capacity-building efforts, the country is on the brink of a significant transformation. The convergence of political commitment, national guidelines, stakeholder engagement, and enhanced public awareness holds the key to a future where evidence-based decision-making becomes the cornerstone of healthcare resource allocation.