BRICS seek value for money as health-care costs rise.

South Africa has set itself the goal of providing universal coverage of health-care services by 2025, with its National Health Insurance system that is being rolled out over 14 years. The challenges are familiar in other low and middle-income countries that have set themselves similar ambitious goals. For Malebona Precious Matsoso, the director-general of the South African National Department of Health, the success of the project relies on improving the scope and quality of public services, and on making the most of scarce public resources. “Technology will play a major role in improving outcomes and the delivery of services, but can be costly,” she writes in the South African Medical Journal in March 2013. “A rigorous, independent mechanism to assess the cost–effectiveness of new technology is required, building on experience of other countries.” In 2011 WHO Member States committed themselves to developing their health financing systems as the basis for universal health coverage and this goal has been underscored by the BRICS countries – Brazil, the Russian Federation, India, China and South Africa – at their annual health ministers’ meetings since 2011. These countries are realizing that without a system to weigh up the benefits and costs of medicines, vaccines, diagnostics and new equipment, costs can soon spiral out of control. That is where health technology assessment comes in. Health technology assessment is a way of weighing up the benefits and costs of two or more health-care options to see which is the best in the given situation. Health technology has its roots in the wealthy industrialized countries, but in the last two decades the approach has taken root in many emerging and developing economies. The International Network of Agencies for Health Technology Assessment has 57 members in 32 countries. One of these is Brazil – a country struggling to maintain universal provision of healthcare services, since it rolled out its unified health system (SUS) in 1988, given that new health-care options are constantly coming on to the market. Among middle-income countries, Brazil is a pioneer in the field. It established its health technology unit in 2003. The National Commission for the Incorporation of Technologies, known by its acronym Conitec, produces studies comparing technologies as well as guidelines for clinical practice and lists of drugs to be reimbursed, according to Conitec President Dr Clarice Alegre Petramale. Conitec has done hundreds of evaluations, she says. About 65% of them have been of new drugs and the rest of medical devices. As a result, 85 new technologies were adopted by Brazil’s public health system over the last two years.