Public policy approaches to funding paediatric medicines in developed public health systems remain understudied. Current approaches to HTA present a variety of conceptual, methodological and practical problems in the context of child health. This study explores the technical and sociopolitical determinants of public funding decisions on paediatric drugs, through the analysis of interviews with stakeholders involved in or impacted by HTA for child health technologies at the provincial and national levels in Canada. We undertook in-depth interviews with a purposive sample (n = 22) of stakeholders involved with or affected by drug funding decisions for children at the provincial (Ontario) and national levels in Canada. Grounded theory methods were employed to guide data collection and analysis. Theory on ‘technology-as-policy’ and the sociopolitics of health technologies served as sensitizing concepts for inductive data coding and analysis. Emergent themes informed the development of conceptual and practical insights on social values and system dynamics related to child HTA, of relevance to public policymaking on the coverage of health technologies for children in Canada. Participant reflection on the normative and systems dimensions of drug funding for children formed two broad categories: HTA paradigms and sociopolitical context. Our analysis revealed notable differences of context and substance related to child health technology production, evaluation and use. These differences spanned the major phases of HTA (from assembly to assessment to integration) and the surrounding sociopolitical milieu (from markets to governance to politics). Careful analysis of these differences sets in relief a number of substantive and procedural shortcomings of current HTA paradigms in respect of child health. Our findings suggest a need to rethink how HTA is structured and operationalized for child health technologies. Current approaches to health technology assessment are not well calibrated to the realities of child health and illness. Our study presents a nuanced and contextually grounded analysis of concepts instrumental to drug funding decisions for children. The insights generated are directly applicable to the Canadian and Ontario contexts, but also yield fundamental knowledge about HTA for children that are germane to drug policy in other health systems.

中文翻译：

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“问题足够小，问题足够大”：对儿童的药品资助决策的卫生技术评估和公共政策的定性研究。

在发达的公共卫生系统中为儿科药物提供资金的公共政策方法仍未得到充分研究。当前的HTA方法在儿童健康方面提出了各种概念，方法和实践问题。这项研究通过对加拿大省级和国家级儿童健康技术涉及或受HTA影响的利益相关者的访谈分析，探索了儿科药物公共资助决策的技术和社会政治决定因素。我们对涉及（或受其影响）加拿大（省）（安大略省）和国家级儿童药物资助决策或受其影响的利益相关者的目标样本（n = 22）进行了深入访谈。扎根的理论方法被用来指导数据收集和分析。关于“技术为政策”的理论和卫生技术的社会政治理论是归纳性数据编码和分析的敏感概念。新兴的主题为有关儿童HTA的社会价值和系统动态的概念和实践见解的发展提供了信息，这些见解与加拿大有关儿童健康技术覆盖面的公共决策有关。参加者对儿童药物供资的规范和制度方面的思考分为两大类：HTA范式和社会政治背景。我们的分析显示，与儿童保健技术生产，评估和使用有关的背景和内容存在显着差异。这些差异跨越了HTA的主要阶段（从组装到评估到整合）和周围的社会政治环境（从市场到治理再到政治）。仔细分析这些差异可以缓解目前HTA范式在儿童健康方面的许多实质性和程序性缺陷。我们的发现表明有必要重新考虑儿童保健技术的HTA的结构和运作方式。当前的卫生技术评估方法未能很好地适应儿童健康和疾病的现实。我们的研究提出了对儿童药物资助决策有帮助的概念的细微差别和基于上下文的分析。产生的见解直接适用于加拿大和安大略省的情况，