Getting fairer over time? Assessing changes in health technology funding processes

Decorative

CHE RESEARCH BITES

By Jing Jing Li, Marcus Sellars, Joanna Coast, Stacy M. Carter, Kirsten Howard, Duncan Mortimer, and Emily Lancsar

13 August, 2026

Deciding which medicines, medical tests, and other health technologies should be funded by publicly funded healthcare systems is challenging.

Resources are limited, and decision-makers must balance competing needs while ensuring that funding decisions are fair, transparent, and based on sound evidence.

This study examined whether Australia's health technology assessment (HTA) processes have become fairer over time by evaluating the work of two key advisory committees: the Pharmaceutical Benefits Advisory Committee (PBAC) and the Medical Services Advisory Committee (MSAC).

The research used the Accountability for Reasonableness (A4R) framework, an internationally recognised approach for assessing fairness in healthcare decision-making. A4R focuses on four elements: using relevant reasons for decisions, making decisions and their justifications publicly available, providing opportunities for review or appeal, and ensuring that fair processes are followed.

Researchers reviewed policy changes made between 2014 and 2022 and conducted interviews with PBAC and MSAC committee members from both time periods. The findings suggest that Australia's HTA processes have become more aligned with principles of fairness over time. Improvements were seen in public transparency, consumer involvement in decision-making, and broader participation in committee deliberations.

Despite this progress, some challenges remain. Commercial confidentiality can limit the amount of information that is publicly available, making it difficult for the public to fully understand why some funding decisions are made. The study also highlighted ongoing difficulties in communicating the complex reasoning behind decisions.

Overall, the findings demonstrate meaningful progress in the fairness of Australia's HTA funding processes and provide valuable lessons for other countries seeking to improve how healthcare funding decisions are made.

The study received funding from the NHMRC Values in Priority Setting Study [APP1047788] & the MRFF “Tools for Outcomes Research to Measure and Value Child Health (TORCH)” [MRFF1199902].

Li JJ, Sellars M, Coast J, Carter SM, Howard K, Mortimer D, Lancsar E. Getting fairer over time? Assessing changes in health technology funding processes using the accountability for reasonableness (A4R) framework. The European Journal of Health Economics, 2026 . DOI: 10.1007/s10198-026-01946-z.

Find out more about the Economic Behaviour, Incentives and Preferences in Health theme.

CHE Research Bites are short, easy-to-understand summaries of our recent academic papers highlighting new evidence and insights on topical issues in the health and healthcare sectors.

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