영국 NICE 의료기술평가의 환자 및 시민참여 경험에 대한 고찰

초록

The patient and public engagement in health technology assessment has increasingly become important for healthcare service to be patient-centered care. For patients and public in Korea, however, there are few chances to be involved in health technology assessment. This study describes the state and background of the patient and public involvement in health technology appraisals at the National Institute for Health and Clinical Excellence(NICE) in UK. In addition, the process evaluation of their participating level and ability to engage in the process, and the outcome evaluation of whether it influenced making a decision over health technology assessment in practice were conducted. To do this, the website of NICE, a book edited by senior staff at NICE on the patient and public involvement in its work, reports evaluating the patient and public involvement in NHS organizations by the House of Commons Health Committee under New Labor Government were used. Additionally, we referred to articles and reports were retrieved from Google Scholar. At NICE in UK, patients, lay people, and organizations standing up for their interest are able to suggest the topic for a formal health technology assessment process, consult on a draft guidance, and appeal to a final guidance. Patient experts as witnesses attend the first meeting of technology appraisals committee where they are expected to provide the evidence of their experiences and preferences. The Citizens Council, comprising of 30 ordinary people from England and Wales, has produced reports containing public views of social and ethical issues followed by making a decision over health technology assessment. They have contributed to establishing the principles of social judgment which were referred to by all advisory bodies of NICE. The main reason why NICE introduced patient and public involvement programs very actively at the outset is that health technology assessment essentially needs the procedural legitimacy for persuading stakeholders to be involved in to comply with a final decision. Although health technology assessment was very sophisticated and demanded advanced knowledge, the patient and the public participated in that process rigourously and mainly consulted on things could be problematic or beneficial to themselves. Their engagement proved a potential to have a practical influence to making a decision over health technology assessment. The support of senior managers and administrational team for their engagement at NICE would lead to such an active participation. These experiences of NICE may make those involved in health technology assessment policy in Korea modify their prejudice that it should be the remit of professionals.

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