Improving transparency of drug formulary decision making in Hospital Authority

Abstract

In 2005, the Hospital Authority (HA) established the Drug Formulary (HADF) with the aim to standardize drug policy and utilization across hospitals and clinics of different clusters in order to ensure equitable access of cost-effective, safe and effective drugs to all patients in Hong Kong. As health budgets are always limited, it is deemed unfeasible for the public healthcare system to provide or subsidize all new drugs to patients. A fair and legitimate process plays an important role in ensuring better alignment and acceptance of the decision made by internal and external stakeholders of HA. This paper described the current drug listing mechanism adopted by the HA and evaluated it using the framework of accountability of reasonableness (A4R) for the level of fairness and legitimacy. The review and evaluation concluded that the drug listing process adopted by HA has shown efforts to enhance the level of publicity and relevancy of decision making but failed to demonstrate right to appeal and enforcement factor as stated in A4R. As revealed from this study, there is inter-dependency between the four conditions in A4R and improving transparency of the HA drug listing mechanism would be the most important condition to enable the actualization of the other three factors.