157:poster Integrating health technology assessment and the right to health in South Africa: a qualitative content analysis of substantive values in landmark judicial decisions

Objective

Some have raised questions about potential tensions between health priority-setting and the right to health. South Africa, which is moving toward HTA and also includes the right to health in its Constitution, is an ideal setting in which to explore whether HTA priority-setting and an existing rights framework can be mutually reinforcing. This presentation discusses the findings of a content analysis that explored whether a focus on case rulings as a source of substantive values can advance understanding of the relationship between a rights-based approach to health care and national HTA efforts.

Methods

We conducted a qualitative content analysis of eight South African court cases related to the right to health. Deductive coding reflected the substantive value framework provisionally developed by the South African Values and Ethics (SAVE) project to inform HTA in South Africa. The focus of analysis was to identify instances in the court’s judgment and related reasoning that identified, interpreted, or balanced the substantive values and considerations included in this framework.

Results

All but one substantive value included in the provisional SAVE framework were identified in the reasoning of at least one judgment. Equity was the most commonly identified value by number of judgments, followed by budget impact. The reasoning for each case judgment was interpretable in terms of the SAVE substantive values. The judgments offer several lessons regarding the interpretation of high-level SAVE values that could be applied in HTA practice.

Discussion

The methodology described here could be applied in other countries where HTA operates in the context of a right to health. If an HTA body is established in SA, researchers should continue to assess the relationship between HTA and the courts to understand how each institution influences the other.