Elsevier

Health Policy

Volume 58, Issue 1, October 2001, Pages 27-35
Health Policy

Application of strengths, weaknesses, opportunities and threats analysis in the development of a health technology assessment program

https://doi.org/10.1016/S0168-8510(01)00149-XGet rights and content

Abstract

There has been recent interest in developing a health technology assessment (HTA) function in Estonia. A group of individuals knowledgeable about HTA in Canada, Germany, Romania and Spain, along with representatives of the University of Tartu, Estonia, was convened by the Institute of Health Economics in Edmonton, Canada, to consider options for such a function. In a one-day workshop strengths, weaknesses, opportunities and threats (SWOT) analyses of HTA were conducted, first at a ‘global’ level, and then of the Estonian situation. The ‘global’ SWOT analysis yielded a large number of items that pertain to institutionalized HTA in a generic sense, i.e. not based on any individual HTA agency. The ‘Estonian’ SWOT yielded a subset of items, which pertain to development of HTA in that country. Ten actionable steps were then developed on the basis of this subset, which could be used to initiate the creation of an HTA body in Estonia.

Introduction

Over the past 10 years, many health technology assessment (HTA) entities have sprung up around the world, which have used various different organizational models [1], [2], [3], [4]. Recently, there has been interest expressed in Estonia for the establishment of an HTA function in the country. Researchers from the University of Tartu, Estonia convened with an international group at the Institute of Health Economics, located in Edmonton, Canada, to discuss options for the implementation and organization of HTA in that country.

An essential part of this discussion was a strengths, weaknesses, opportunities and threats (SWOT) analysis, first of general issues in institutionalized HTA and second, for the specific situation in Estonia.

SWOT analysis can be simply understood as the examination of an organization's internal strengths and weaknesses, and the opportunities and threats faced by the organization due to its environment. Originally designed for use in an industrial environment it is a general tool intended to be used in the preliminary stages of decision-making and as a precursor to strategic planning in various kinds of applications [5]. This technique has so far not been widely used in the health sector [6], [7], [8] and not at all in the context of HTA. In this paper, a structured process is described which clarifies the steps that may be taken in the context of future establishment of HTA in Estonia by using a group-based SWOT-analysis.

Section snippets

Methods

A group of individuals knowledgeable about the status of organized HTA in Canada, Germany, Romania and Spain was brought together with representatives of the University of Tartu. A one-day workshop was conducted using four steps.

Step 1: As a first step, characteristics of the health care systems in the five countries and of HTA developments and activities in Canada, Germany, Spain and Romania were described [9], [10], [11], [12]. This step was divided in two parts: description of the macro

Results

The health care systems in these countries are considerably different from each other. In part as a result of this, development of institutionalized HTA has been different, and the rate of evolution has varied. Spain and Canada have had well-developed HTA agencies for a number of years. Both health care systems are government run, tax based, and the need for HTA was identified early. Consequently, HTA activities are established both on a national and provincial level. In addition steps are

Discussion

Many HTA organizations have been created in the past decade [16]. Typically, in the development of a new HTA body, there are consultations with individuals from established agencies, and reviews of existing models and published material. In the present case, a small multi-national group was used to aid in planning for a new HTA agency in Estonia. This exercise has shown that SWOT analysis can be a useful and quick way of exploring ways to develop an HTA agency – in this case, in Estonia.

Conclusion

The four steps of a group based SWOT-analysis were found useful as a basis for the establishment of an HTA body in Estonia. However, whether they will yield the right return cannot be predicted. Since the actions are dependent on the specific environment in which they arise, continual reassessment will be necessary. A starting point in this whole endeavor is the development of actions and decisions that will shape and guide the future direction.

Acknowledgements

We are indebted to Leigh Ann Topfer and Don Juzwishin for their valuable comments.

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