Abstract：
BACKGROUND: Health care coverage decisions deal with health care technology provision or reimbursement at a national level. The coverage decision report, i.e., the publicly available document giving reasons for the decision, may contain various elements: quantitative calculations like cost and clinical effectiveness analyses and formalised and non-formalised qualitative considerations. We know little about the process of combining these heterogeneous elements into robust decisions.
METHODS: This study describes a model for combining different elements in coverage decisions. We build on two qualitative cases of coverage appraisals at the Dutch National Health Care Institute, for which we analysed observations at committee meetings (n = 2, with field notes taken) and the corresponding audio files (n = 3), interviews with appraisal committee members (n = 10 in seven interviews) and with Institute employees (n = 5 in three interviews), and relevant documents (n = 4).
RESULTS: We conceptualise decisions as combinations of elements, specifically (quantitative) findings and (qualitative) arguments and values. Our model contains three steps: 1) identifying elements; 2) designing the combinations of elements, which entails articulating links, broadening the scope of designed combinations, and black-boxing links; and 3) testing these combinations and choosing one as the final decision.
CONCLUSIONS: Based on the proposed model, we suggest actively identifying a wider variety of elements and stepping up in terms of engaging patients and the public, including facilitating appeals. Future research could explore how different actors perceive the robustness of decisions and how this relates to their perceived legitimacy.
METHODS: This study describes a model for combining different elements in coverage decisions. We build on two qualitative cases of coverage appraisals at the Dutch National Health Care Institute, for which we analysed observations at committee meetings (n = 2, with field notes taken) and the corresponding audio files (n = 3), interviews with appraisal committee members (n = 10 in seven interviews) and with Institute employees (n = 5 in three interviews), and relevant documents (n = 4).
RESULTS: We conceptualise decisions as combinations of elements, specifically (quantitative) findings and (qualitative) arguments and values. Our model contains three steps: 1) identifying elements; 2) designing the combinations of elements, which entails articulating links, broadening the scope of designed combinations, and black-boxing links; and 3) testing these combinations and choosing one as the final decision.
CONCLUSIONS: Based on the proposed model, we suggest actively identifying a wider variety of elements and stepping up in terms of engaging patients and the public, including facilitating appeals. Future research could explore how different actors perceive the robustness of decisions and how this relates to their perceived legitimacy.
摘要：
背景：医疗覆盖决策涉及国家层面的医疗技术提供或报销。覆盖决策报告，即，公开提供决定理由的文件，可能包含各种要素：定量计算，如成本和临床效果分析以及正式和非正式的定性考虑。我们对将这些异构元素组合成稳健决策的过程知之甚少。
方法：本研究描述了在覆盖决策中组合不同元素的模型。我们以荷兰国家卫生保健研究所的两个定性覆盖率评估案例为基础，为此，我们分析了委员会会议上的观察结果(n=2，实地记录)和相应的音频文件(n=3)，与评估委员会成员的访谈（七次访谈中n=10）和与研究所员工的访谈（三次访谈中n=5），和相关文件(n=4)。
结果：我们将决策概念化为元素的组合，特别是(定量)结果和(定性)论点和价值观。我们的模型包含三个步骤：1)识别元素；2)设计元素的组合，这需要明确的链接，扩大设计组合的范围，和黑箱链接；3）测试这些组合并选择一个作为最终决定。
结论：基于所提出的模型，我们建议积极寻找更广泛的因素，并加强让患者和公众参与，包括促进上诉。未来的研究可以探讨不同的行为者如何看待决策的稳健性，以及这与他们感知的合法性有何关系。
方法：本研究描述了在覆盖决策中组合不同元素的模型。我们以荷兰国家卫生保健研究所的两个定性覆盖率评估案例为基础，为此，我们分析了委员会会议上的观察结果(n=2，实地记录)和相应的音频文件(n=3)，与评估委员会成员的访谈（七次访谈中n=10）和与研究所员工的访谈（三次访谈中n=5），和相关文件(n=4)。
结果：我们将决策概念化为元素的组合，特别是(定量)结果和(定性)论点和价值观。我们的模型包含三个步骤：1)识别元素；2)设计元素的组合，这需要明确的链接，扩大设计组合的范围，和黑箱链接；3）测试这些组合并选择一个作为最终决定。
结论：基于所提出的模型，我们建议积极寻找更广泛的因素，并加强让患者和公众参与，包括促进上诉。未来的研究可以探讨不同的行为者如何看待决策的稳健性，以及这与他们感知的合法性有何关系。
