Innovating Health: Public engagement in health technology assessments and coverage decisions


Discontent with how healthcare decisions are made and justified is widespread among the public, patients and providers of health technologies alike. The Public Policy Forum held five roundtables across Canada to discuss how public engagement in health technology assessments (HTAs) and coverage decisions can help lead to more transparent decisions that find greater support among all stakeholders.

Several reasons can help explain the current discontent with healthcare decisions:

  • A lack of transparency about the criteria used in HTAs and coverage decisions;
  • Healthcare decisions replete with significant ethical dimensions;
  • HTAs not capturing some costs and benefits of treatments adequately; 
  • Dissatisfaction with the overbearing influence of cost and budget considerations; and
  • A lack of meaningful avenues of involvement for patients and the public.

Bringing public and patient perspectives into the process in a meaningful and transparent way can help address the above issues. Attempts at this have been made in the past, and are being experimented with in the present, but often have not been designed and implemented to make a substantial and genuine difference in the process of assessing health technologies and arriving at transparent coverage decisions.

This report details the full scope of Forum's work in this critical area of health innovation. It finds that patient and public engagement in health decision-making is a useful objective and, with the proper leadership and guidance, should be pursued in all Canadian jurisdictions. A more robust system, supported and informed by more active citizens, will be the result.