This document discusses the relationship between health technology assessment (HTA) and healthcare procurement in supporting appropriate use of health technologies. While HTA and procurement share roles in patient outcomes, quality and cost, they differ in their processes and criteria. HTA focuses on evidence-based clinical and cost-effectiveness while procurement adjudicates fair competitive bidding processes. The document analyzes how HTA and procurement are articulated in four Canadian provinces, finding early efforts to connect them formally but disjuncture in their evaluative frameworks. It concludes that both fields could learn from each other to better support comprehensive technology management and value-based decision making.

1. Two solitudes?
HTA & Procurement as
pathways to the
adoption of non-drug
health technologies
FA Miller, C Barg,
M Krahn, P Lehoux,
S Peacock, VE Rac
CADTH, Saskatoon
April 14, 2015

2. Same, same …
HTA & Healthcare Procurement share
 Roles in supporting the appropriate utilization of
health technologies in health systems
 Patient outcomes, quality, safety
 Public policy attention, given cost pressures
and sustainability concerns
 Principle missions with respect to health policy
 Accordingly, the objects of criticism by industry
 Though increasingly asked to consider ‘double
promise’* with respect to wealth and health
*Morrison, Michael, and Lucas Cornips. "Exploring the role of dedicated online biotechnology news providers in
the innovation economy." Science, Technology & Human Values 37.3 (2012): 262-285.

3. … but different
HTA
 Limited statutory conditions on
action
 Provides guidance for limited
number of technologies
 Subject to limited regulatory
directives
 Creature of health policy
 Touchstones
 Evidence-based medicine
 Value for money
 Patient & social values
Procurement
 Substantial statutory conditions
on action
 Manages adoption for most
technologies
 Subject to trade agreements
and statutory directives
 Creature of Finance/ Treasury
Board policy
 Not always a creature of
Health policy
 Touchstones
 Fraud & Corruption
 Waste
 Competition & Transparency

4. … quite different
HTA
 Adjudicate comparative clinical
and cost effectiveness
 Evidence-based
 Critical appraisal of
relevant clinical evidence
 Value-for money
 Cost per QALY
 Patient & social values
 Patient values &
preferences
 Citizen values
 Accountability for
Reasonableness
Procurement
 Adjudicate transparent, fair and
competitive process
 “Request for proposals”
 Pre-specified criteria
 Mandatory requirements
 Envelope 1: Technical/
Quality requirements
(Clinical, Service Level,
Device and Product
Performance
Requirements)
 May involve site trial
 Envelope 2:
Business/Financial
requirements

5. Study
Role of procurement in adoption of
‘innovative’ non-drug health technologies
in Canada
 Phase 1: Comparative analysis of procurement
arrangements across selected provinces –
Quebec, Ontario, Alberta, BC
 Case studies – documents, interviews, non-
participant observation
 Review of Requests for Proposals
 Phase 2: Analysis of procurement in practice
 Comparative analysis of tracer technologies
across sites/ provinces

6. Study
Role of procurement in adoption of
‘innovative’ non-drug health technologies
in Canada
 Phase 1: Comparative analysis of
procurement arrangements across selected
provinces – Quebec, Ontario, Alberta, BC
 Case studies – documents, interviews, non-
participant observation
 Review of Requests for Proposals
 Phase 2: Analysis of procurement in practice
 Comparative analysis of tracer technologies
across sites/ provinces

7. A brief history of
procurement
BC, Alberta, Quebec, Ontario

8. Concurrent developments
Organization
 Increases in collective buying power,
and efficiencies
 Group purchasing organizations –
GPOs
 Across jurisdictions
 E.g., HealthPRO (1996)
 Owned by member
shareholders across 7
provinces/territories; > 260
members, > 800 facilities
 Joint purchasing groups
 Within jurisdictions
 Often associated with shared
“back offices” – so “Shared
Service Organizations” (SSOs)
 Accounts receivable, Payroll,
Technology Services, etc.
Regulation
 Developments in procurement
regulation
 Trade agreements
 Agreement on Internal Trade,
1995
 New West Partnership Trade
Agreement, 2010 (Alberta, BC,
Saskatchewan)
 Canadian-European
Comprehensive Economic &
Trade Agreement (CETA), 2014+
 Reform of procurement policy –
often driven by scandal
 Tends to increase formalization &
standardization
 Overlay of new requirements
on already complex systems
 Chilling effect on relations with
suppliers

9.  BC & Alberta
 Organizational reform – 1 Procurement organization
 Driven by Ministries of Health
 Single centralized mandatory procurement organization
 Aligned with scope and budget of regional health authorities (not
physician services)
 Regulatory reform not dominated by scandal
 Quebec
 Organizational reform – 3 Procurement organizations
 Recent MSSS efforts to reduce number of joint procurement groups
and increase use of joint procurement
 Partial alignment with scope and budget of ‘regions’
 Regulatory reform dominated by scandal
 Ontario
 Organizational reform – 9 +++ procurement organizations
 Ministry of Finance/ Government & Consumer Services financial
encouragement for shared services organizations
 MOHLTC AWOL
 No alignment with regional scope or budget
 Regulatory reform influenced by scandal

10. Articulation with HTA
BC, Alberta, Quebec, Ontario

11.  BC & Alberta
 Active effort to coordinate between HTA and procurement
 Focus on adoption of novel/ expensive technologies
 BC
 Health Technology Review committee includes representative
from HSSBC
 HSSBC conducts “parallel” intake process for health
technologies ‘out of scope’ for the Health Technology Review
 Alberta
 Part of new product introduction/ product evaluation process
 Assess whether needs HTA
 Regular meetings - CPSM & HTAI
 Quebec
 Recent directive on mandatory joint procurement
 That procurement take into consideration data from HTA
 Coordinating & Monitoring Committee includes INESS
 Ontario
 None

12. Two solitudes?
Conditions for aligning HTA &
Procurement

13. Conclusion, 1
 Public sector procurement a longstanding
focus of public policy
 Trade agreements
 Transparent, non-discriminatory competition
 Growing attention to procurement as public
policy instrument for other aims
 In broader public sector
 Reduced costs through volume-based aggregation &
purchase efficiencies
 In health sector – specific missions
 Health outcomes
 Quality & safety through product standardization,
usability/ safety
 In some jurisdictions – other missions
 Green procurement, Ethical procurement, Innovation
procurement, SME procurement

14. Conclusion, 2
 Early efforts to elaborate formal connections
between HTA & Procurement
 Related to capacity to coordinate health ‘system’
 Related to involvement of Health Ministries in
health procurement reform
 Ontario the outlier in all respects
 Even as formal ties develop, disjuncture in
evaluative frameworks
 Shared knowledge limited
 Most RFAs support “lowest cost compliant” bids
 Emphasis of shared effort on ‘front end’
 Classic HTA concern with “the new” and
expensive

15. Lessons learned …
HTA
 Opportunity for impact
 Key for non-drug technologies
 Learning from procurement
 Understanding the
organizational challenges of
adoption & use
 Comprehensive management
of technology – medtech
formularies
 Valuing other missions
 Ethical, green, SME
procurement
Procurement
 Learning from HTA
 Value-based purchasing
 Evidence-informed indication
and volume management
 Methods for clinical pathway
management
 System-lens on value of
technology

16. Questions?
Thank you