Objectives: The objectives of this study are to review the financing and organization of the Argentine healthcare system, the licensing and drug price setting mechanisms, the benefit packages and coverage policies of pharmaceuticals and other medical technologies, as well as the development of HTA in Argentina, and the role of the Institute of Clinical Effectiveness and Health Policy (IECS) as an HTA agency. Finally, the perspectives and future of HTA as a tool to make resource-allocation decisions and priority setting in Argentina is discussed.

Methods: The study is a discussion/review based largely on the experiences of the authors, but supported by available literature.

Results: Argentina is an upper-middle income country with major healthcare problems related to both equity and efficiency. Its healthcare system consists of a multitier system divided in three large sectors: public, social security, and private, where the federal Ministry of Health has a rather limited role in national health policy stewardship. Many of Argentina's shortcomings are due in part to its pluralistic and fragmented healthcare system. In the past decade, Argentina, like many other Latin American countries, has undergone a profound reform of its healthcare system. Whereas some of the objectives of the reforms were specific to each country, a common issue among all of them was to establish a mechanism that ensured a more efficient allocation of scarce resources, and guaranteed a wider provision of healthcare services on the basis of the local population needs and equity. Although some signals from the national government and congress show that there are plans to formally incorporate HTA to inform reimbursement policies, these signals are still very weak. Paradoxically, even though Argentina was the first country in the region to require formal health economic evidence for the adoption of technologies into the mandatory benefit package of the social security, this “fourth hurdle” is no longer required. Nevertheless, there is an increasing interest and demand for a more explicit and transparent resource-allocation process that include HTA as a formal tool to inform decision making, in most of Argentine healthcare stakeholders.

Conclusions: In conclusion, what is needed in Argentina is a clear political will to push forward for a national agency of HTA that, similar to other developed countries, advance the regulation on the adoption of new health technologies to improve not only technical or allocative efficiency, but also health equity. Until this milestone is accomplished, the HTA production and use to inform healthcare coverage policies will continue to mirror the current fragmented healthcare system.

Objectives: The history of health technology assessment (HTA) in Mexico is examined, starting with the efforts to incorporate this topic into the policy agenda and culminating with the recent creation of a specialized public agency.

Methods: Information was gathered through a bibliographic search and interviews with actors involved in HTA in Mexico.

Results: HTA efforts were developed in Mexico since the mid-1980s with the participation both of academics and of policy makers, a relationship that eventually led to the creation of the Center for Technological Excellence within the Ministry of Health.

Conclusions: Institutionalization of HTA in resource-constrained settings requires the development of a critical mass of researchers involved in this field, the implementation of information efforts, and the establishment of strong relationships between HTA experts and policy makers.

The author argues that a “narrowing down” in the scope of HTA that occurred at the end of the 1970s was paralleled by developments in bioethics at the same time. Both disciplines responded to changes in the institutional and political field in which they operated. Over the past 20 years, decision making in the health field has changed again. To remain relevant, HTA must evolve further. Building in mechanisms for consultation with stakeholders will be an important element in this adjustment.

The collective experience of health technology assessment (HTA) in different countries delineates a pattern of development, a “natural history,” of HTA in three phases: emergence, consolidation, and expansion. This study examines the rationale for HTA, definitions of its scope and breadth, its methods and organizational models, and its knowledge translation strategies, as HTA moves from one phase to the next. The study then identifies factors that facilitate or delay the transitions.

I have long felt the need for documentation on the global development—I could probably pin it to the moment I was visiting health technology assessment (HTA) institutions in the United States in 1995, and was looking forward to a trip to the Office of Technology Assessment, only to be told it had just been shut. Instead, I visited the Office of Health Technology Assessment in Washington. In addition, I have observed that some regular attendees of annual meetings of International Society of Technology Assessment in Health Care (ISTAHC) and then Health Technology Assessment International (HTAi), have been slowly dropping out, so that a lot of the history as well as their valuable experiences and expertise have been lost. To be fair, studies have been written about specific HTA institutions, programs, countries, and even regions. Attempts have also been made to chart the history of HTA, but these have, however, fizzled out. Why is this important? Going back to my personal experience, when I first set out to establish HTA in Malaysia, I was plagued with several questions—apart from the obvious one about what HTA really meant, there were others like what organization structure should it have, what should be the work process, how could HTA be used, to name a few. I needed to know what the options were, for example, in coming up with an organizational structure, and to understand these options I would need to look at organizational models in other countries—should it be a national office with regional offices like the Canadian model, or a fully public agency but not within the department of health, like the Swedish model, or an almost independent agency like the Catalan agency in Barcelona. In the absence of a detailed account with the information I sought, I actually had to physically visit various agencies to study their organizational structure, work process, and application, to hear of the challenges they faced, and to learn from their experiences of what could work and what may not.