Health Policy 105 (2012) 236–245 Contents lists available at SciVerse ScienceDirect Health Policy j ourna l ho me p ag e: www.elsevier.com/locate/healthpol Stakeholders involvement by HTA Organisations: Why is so different? Marianna Cavazza a,∗ , Claudio Jommi b a CERGAS (Centre for Health and Social Care Management), Università Bocconi, Via Roengten 1, 20136 Milan, Italy b Department of Pharmaceutical Sciences, Università del Piemonte Orientale, Novara, Italy a r t i c l e i n f o Article history: Received 23 September 2011 Received in revised form 23 January 2012 Accepted 24 January 2012 JEL classification: I180 O38 Keywords: HTA Healthcare system Policy-making Stakeholders Administrative tradition a b s t r a c t Objective: To investigate stakeholder involvement by Health Technology Assessment Organisations (HTAOs) in France, Spain, England and Wales, Germany, Sweden, and The Netherlands and to examine whether this involvement depends on (i) the administra- tive tradition and the relevant conception of the relationship between state and society (contractarian and corporative vs. organic), (ii) the general structure of the healthcare sys- tem (HCS) (Bismarckian vs. Beveridgian system), and (iii) the role of Health Technology Assessment (HTA) and HTAOs in the HCS. Methods: Given the exploratory nature of the study, we considered interviews based on semi-structured questionnaires the most appropriate data-gathering technique. The inter- views were administered to 16 key personnel in the HTAOs concerned. We have also carried out a literature review on HTAOs and stakeholders (1999–2011) using PubMed, Ebsco, JSTOR and Wiley Science. Results: In contractarian and (to a lesser extent) Bismarckian models, stakeholders are more involved. The administrative tradition and the HCS appear less important when the HTA is binding and used for regulatory purposes. In such situations, stakeholders are more inten- sively involved because their participation provides an opportunity for HTAOs to achieve consensus and legitimacy in advance. Conclusions: Despite the limitations of the research (we did not conduct multiple interviews for each HTAO, and key informants were not always available) and its exploratory nature, we can conclude that models of stakeholders involvement cannot easily be transferred from one country to another due to the importance of national administrative traditions and the characteristics of HCSs. © 2012 Elsevier Ireland Ltd. All rights reserved. 1. Introduction The introduction of new technologies into a healthcare system is regulated by policy makers [1], who are expected to promote allocative efficiency and to control costs. Health Technology Assessment (HTA) provides policy makers with the technical support required for their regulatory action [2]. Policy makers might not manage HTAs on their own and could depend on the support of HTA organisations ∗ Corresponding author. Tel.: +39 02 5836 2664. E-mail addresses: marianna.cavazza@unibocconi.it (M. Cavazza), claudio.jommi@pharm.unipmn.it (C. Jommi). (HTAOs) [3,4]. Furthermore, the implementation of a HTA is a complex and multidimensional process [5]. Hence, unless HTAOs hold all the required competences and information internally, they require the technical support, information and expertise provided by stakeholders. The involvement of stakeholders could also guarantee the legitimacy of the final assessment and help prevent conflict after the tech- nologies have entered the market [6,7]. The literature on HTAOs demonstrates (i) significant similarities among the HTAOs in the way they formally organise the assessment process and in the technical issues of decision making (e.g., the parameters used for setting priorities) and (ii) important differences among HTAOs in how the decision-making process is actually 0168-8510/$ – see front matter © 2012 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.healthpol.2012.01.012