Health technology assessment and the international right to health : interpreting state obligations in resource distribution and mobilisation

The thesis investigates to what extent the international right to health can generate standards for Health Technology Assessment (HTA) implementation and policies. HTA has been used as a multidisciplinary process to determine the broad impact and cost-effectiveness of new healthcare technologies and interventions in health systems under multiple levels of resource constraints. By exploring the relation of this process with State measures to promote access to health, this thesis proposes a human rights-based approach (HRBA) to HTA focused on controlling economic relations and ensuring favourable conditions for access to healthcare. The central point of analysis is how the premise of scarcity, which inspired procedural approaches in bioethics and right to health litigation studies, is not rigid and can be mitigated by State continuous efforts during HTA. The normative focus is on Article 2.1 of the International Covenant on Economic, Social and Cultural Rights, concerning fundamental principles of progressive realisation and maximum available resources. In this doctrinal analysis, the notion of resources is expanded so as to include State regulatory power at large to contain scarcity through laws alongside HTA decisions. Resources, in this interpretation, involve enabling affordable healthcare, obligations of international cooperation and State support to evidence-making and knowledge production that enhance HTA criteria. A case study in Brazil indicates how the procedural justice model is insufficient to guide State responses to scarcity. A documentary analysis suggests that policies and law can be in practice applied as prescribed by the international economic and social rights principles concerning resource mobilisation, which cannot be divorced from resource allocation in political deliberations. Therefore, an HRBA to HTA should not be read as merely procedural justice but should also impose obligations to address the causes of scarcity where possible before overdependence on rationing deliberations.