disinvestment in asia-pacific: how can this be implemented
TRANSCRIPT
Title Slide1
Disinvestment in Asia-Pacific: How can this be implemented in HTA and what can be learnt from Europe?
IP2, ISPOR 6th Asia Pacific Conference
2
Panellists:
• Isao Kamae, MD, PhD. HTA and Public Policy Project, Graduate School of Public Policy, The University of Tokyo
• Seang Teak Tan, MSc, MBA. VP Project Management, Gleneagles Hong Kong Hospital
• Iñaki Gutiérrez-Ibarluzea, MSc, PhD. Knowledge Manager, Osteba – Basque Office for HTA, Basque Government
2
3
Health technology life cycle
1. Goodman HC, Goodman CS. HTA 101 Introduction to health technology assessment. Citeseer; 2004.
Stages of diffusion and maturity of health technologies1
Future
Experimental
Investigational
Established
Obsolete
Time
DISINVESTMENT
INVESTMENT
4
What is disinvestment?
1. Elshaug AG, Hiller JE, Tunis SR, Moss JR. Challenges in Australian policy processes for disinvestment
from existing, ineffective health care practices. Aust New Zealand Health Policy. 2007;4:23.
“Disinvestment is the process of withdrawing health resources from any existing health care practices,
procedures, technologies, or pharmaceuticals that are deemed to deliver little or no health gain for their
cost and thus do not represent efficient health resource allocation.”1
Decommissioning
Delisting
Why disinvestment?
• There is a global pattern of rising costs for healthcare systems, one of the main drivers being the adoption of new health technologies
• The safety, efficacy, effectiveness and cost-effectiveness of many established technologies have never been robustly assessed
• Currently, there are no formal guidelines or frameworks for disinvestment in Asia-Pacific
• A formal framework for disinvestment analysis and implementation would improve patient care and streamline resource allocation decisions
• Also, an early discussion for the development of a disinvestment framework would be beneficial for:
• Avoiding duplication of effort (efficient allocation of resources across Asia-Pacific countries)
• Knowledge sharing and support of countries with less developed HTA systems
6
1. Experience in disinvestment processes in Asia-Pacific: Japan
2. Disinvestment at hospital level in Asia-Pacific
3. Lessons learnt from disinvestment experiences in Europe
Discussion
4
ISPOR 6th Asia-Pacific Conference
Isao Kamae, MD, DrPH
Professor, Graduate School of Public Policy, The University of Tokyo
Adjunct Professor, Meiji Institute for Global Affairs, Meiji University
Adjunct Professor, Graduate School of Medicine, Kobe University
Research Director, The Canon Institute for Global Studies
Japan
Dilemma globally confronted in health policy
HTA as a key concept
Market freedom: investment-driven
Health Expenditure & Life Expectancy: evolvement during 1995 - 2010 in selected countries
Size of the circle indicates total population. The figure was achieved from Gapminder World: http://www.gapminder.org/
10
T o
per NI
per GDP
Trillion Yen
Environment: nuclear power plant?
Health care organization: hospital/system
management
Tradeoffs: limited resources vs. limitless
demand
individuals
Key questions for prioritisation
S a fe
Regional level: 3, 4, 5
Site level: 6, 7
restriction of physician's autonomy
local government-driven healthcare systems
preferential taxation for physicians/hospitals
Policy
Focus on the sectors which can provide environments ensuring
healthcare with safety and high quality management
Re-pricing rates: Total average +0.004%
Non-drugs (professional fees) +1.38% (JPY550B)
Medical +1.55% (JPY470B)
Revised rates of medical fee, 1998 - 2012
Non-drugs
Drugs
Average
9
Collaboration
ICER under budget constraint
Poster PRM36. Kamae I et al, 6th ISPOR AP, Beijing 2014
10
Conclusion
investment.
Disinvestment is less focused than investment.
Each country has its own mechanism for disinvestment.
Disinvestment processes/rules are not transparent nor
value-based.
Methodology specific to Asia must be established.
19
DISINVESTMENT IN ASIA-PACIFIC: HOW CAN THIS BE IMPLEMENTED IN HTA AND WHAT CAN BE LEARNT FROM EUROPE?
Seang Teak Tan, BSc, MSc, MBA VP Project Management Gleneagles Hong Kong Hospital Hong Kong
11
Obstacles that lie in the path of Asia Pacific’s ambitious private hospitals:
• i) doctors and nurses are scarce
• ii) regulations can be treacherous
• iii) market uncertainty
• v) long gestation period
• Continuity of care
12
Our Typical feasibility study for investing in the establishment of a hospital
Process to assess the investment in health technologies in a typical hospital
13
Process to assess the disinvestment in health technologies in a typical hospital
Clinical Risk Management Subcommittee:
• Chaired by senior clinician
• Supported by risk management
• Formulate, implement, coordinate, monitor and review risk reduction
• Including patient risk identification, safe surgery, medication safety, infection control, fall prevention & management, decontamination safety, clinical waste management etc...
Disinvestment at the hospital level: examples
1. Robotic surgery
4. Digital imaging equipment vs film
14
DISINVESTMENT IN ASIA-PACIFIC: HOW CAN THIS BE IMPLEMENTED IN HTA AND WHAT CAN BE LEARNT FROM EUROPE?
Dr. Iñaki Gutiérrez-Ibarluzea Secretary of HTAi Osteba. Osasun Teknologien Ebaluazioaren Zerbitzua. Basque Office for HTA. Osasun Saila Ministry for Health Eusko Jaurlaritza Basque Government
15
"I've seen things you people wouldn't believe.
Attack ships on fire off the shoulder of Orion. I watched C-beams glitter in the dark near the Tannhauser gate. All those moments will be lost in time... like tears in rain... Time to die.”
Blade runner
• In relation to Obsolete technologies:
Less interest on efficacy and effectiveness data
collection after the adoption of a technology
• In relation to Disinvestment:
Alternative technologies and target population
Disinvestment of obsolete technologies depends on
obsolete definition
Non cost-effective Redundant
Obsolete definition?
What should be taken into account:
• High impact technologies? Eg: technologies with CLEAR SUBSTITUTIVE and that the change implies investment or adaptation…
• Areas in which vulnerable populations are not affected
• Start in areas that aren’t controversial or suppose low impact?
• Start in areas in which safety and effectiveness are controversial?
Methodological guidelines
obsolete technologies
context:
EuroScan)
IDENTIFICATION and ASSESSMENT
EuroScan database
Specially in prescription of drugs and variability surgical procedures and diagnostics
Identification
Ophthalmology
• More collaborative experts:
Technological frustration
Identification: things to learn from our experience
19
obsolete?
substituted by an alternative
technology
account
GuNFT guideline
the potential for disinvestment
in certain health technologies
which, for whatever reason, fail
to achieve the objective(s) for
which they were originally
Nominal Group
• Life cycle of technologies is a more appropriate concept
• Different processes are comprised
Identification of health needs
Effective implementation of technologies
Delisting or disinvestment of technologies of low-added or no added value
Initiatives currently in practice
• Horizon scanning / Early Awareness
• Early Dialogue.
Concept papers and guidances
CONCLUSIONS
• Same evidence could lead to different recommendations and actions
• HTA is needed at the three levels of decision (micro, meso and
macro) and at the three main decision moments (investment,
practice and disinvestment)
• HTA initiatives that have been focused at the macro level are not successful
• The life cycle concept of health technologies needs to be considered
• Identify the customer and feed its needs
• Importance of the combination of methods (qualitative and
quantitative) for the identification of problems and the reasons that
justified them
An aid can be the start of a promising future
For more clarifications
• Dr. Iñaki Gutiérrez-Ibarluzea
Secretary of HTAi
Research and Innovation Directorate
Disinvestment in Asia-Pacific: How can this be implemented in HTA and what can be learnt from Europe?
IP2, ISPOR 6th Asia Pacific Conference
2
Panellists:
• Isao Kamae, MD, PhD. HTA and Public Policy Project, Graduate School of Public Policy, The University of Tokyo
• Seang Teak Tan, MSc, MBA. VP Project Management, Gleneagles Hong Kong Hospital
• Iñaki Gutiérrez-Ibarluzea, MSc, PhD. Knowledge Manager, Osteba – Basque Office for HTA, Basque Government
2
3
Health technology life cycle
1. Goodman HC, Goodman CS. HTA 101 Introduction to health technology assessment. Citeseer; 2004.
Stages of diffusion and maturity of health technologies1
Future
Experimental
Investigational
Established
Obsolete
Time
DISINVESTMENT
INVESTMENT
4
What is disinvestment?
1. Elshaug AG, Hiller JE, Tunis SR, Moss JR. Challenges in Australian policy processes for disinvestment
from existing, ineffective health care practices. Aust New Zealand Health Policy. 2007;4:23.
“Disinvestment is the process of withdrawing health resources from any existing health care practices,
procedures, technologies, or pharmaceuticals that are deemed to deliver little or no health gain for their
cost and thus do not represent efficient health resource allocation.”1
Decommissioning
Delisting
Why disinvestment?
• There is a global pattern of rising costs for healthcare systems, one of the main drivers being the adoption of new health technologies
• The safety, efficacy, effectiveness and cost-effectiveness of many established technologies have never been robustly assessed
• Currently, there are no formal guidelines or frameworks for disinvestment in Asia-Pacific
• A formal framework for disinvestment analysis and implementation would improve patient care and streamline resource allocation decisions
• Also, an early discussion for the development of a disinvestment framework would be beneficial for:
• Avoiding duplication of effort (efficient allocation of resources across Asia-Pacific countries)
• Knowledge sharing and support of countries with less developed HTA systems
6
1. Experience in disinvestment processes in Asia-Pacific: Japan
2. Disinvestment at hospital level in Asia-Pacific
3. Lessons learnt from disinvestment experiences in Europe
Discussion
4
ISPOR 6th Asia-Pacific Conference
Isao Kamae, MD, DrPH
Professor, Graduate School of Public Policy, The University of Tokyo
Adjunct Professor, Meiji Institute for Global Affairs, Meiji University
Adjunct Professor, Graduate School of Medicine, Kobe University
Research Director, The Canon Institute for Global Studies
Japan
Dilemma globally confronted in health policy
HTA as a key concept
Market freedom: investment-driven
Health Expenditure & Life Expectancy: evolvement during 1995 - 2010 in selected countries
Size of the circle indicates total population. The figure was achieved from Gapminder World: http://www.gapminder.org/
10
T o
per NI
per GDP
Trillion Yen
Environment: nuclear power plant?
Health care organization: hospital/system
management
Tradeoffs: limited resources vs. limitless
demand
individuals
Key questions for prioritisation
S a fe
Regional level: 3, 4, 5
Site level: 6, 7
restriction of physician's autonomy
local government-driven healthcare systems
preferential taxation for physicians/hospitals
Policy
Focus on the sectors which can provide environments ensuring
healthcare with safety and high quality management
Re-pricing rates: Total average +0.004%
Non-drugs (professional fees) +1.38% (JPY550B)
Medical +1.55% (JPY470B)
Revised rates of medical fee, 1998 - 2012
Non-drugs
Drugs
Average
9
Collaboration
ICER under budget constraint
Poster PRM36. Kamae I et al, 6th ISPOR AP, Beijing 2014
10
Conclusion
investment.
Disinvestment is less focused than investment.
Each country has its own mechanism for disinvestment.
Disinvestment processes/rules are not transparent nor
value-based.
Methodology specific to Asia must be established.
19
DISINVESTMENT IN ASIA-PACIFIC: HOW CAN THIS BE IMPLEMENTED IN HTA AND WHAT CAN BE LEARNT FROM EUROPE?
Seang Teak Tan, BSc, MSc, MBA VP Project Management Gleneagles Hong Kong Hospital Hong Kong
11
Obstacles that lie in the path of Asia Pacific’s ambitious private hospitals:
• i) doctors and nurses are scarce
• ii) regulations can be treacherous
• iii) market uncertainty
• v) long gestation period
• Continuity of care
12
Our Typical feasibility study for investing in the establishment of a hospital
Process to assess the investment in health technologies in a typical hospital
13
Process to assess the disinvestment in health technologies in a typical hospital
Clinical Risk Management Subcommittee:
• Chaired by senior clinician
• Supported by risk management
• Formulate, implement, coordinate, monitor and review risk reduction
• Including patient risk identification, safe surgery, medication safety, infection control, fall prevention & management, decontamination safety, clinical waste management etc...
Disinvestment at the hospital level: examples
1. Robotic surgery
4. Digital imaging equipment vs film
14
DISINVESTMENT IN ASIA-PACIFIC: HOW CAN THIS BE IMPLEMENTED IN HTA AND WHAT CAN BE LEARNT FROM EUROPE?
Dr. Iñaki Gutiérrez-Ibarluzea Secretary of HTAi Osteba. Osasun Teknologien Ebaluazioaren Zerbitzua. Basque Office for HTA. Osasun Saila Ministry for Health Eusko Jaurlaritza Basque Government
15
"I've seen things you people wouldn't believe.
Attack ships on fire off the shoulder of Orion. I watched C-beams glitter in the dark near the Tannhauser gate. All those moments will be lost in time... like tears in rain... Time to die.”
Blade runner
• In relation to Obsolete technologies:
Less interest on efficacy and effectiveness data
collection after the adoption of a technology
• In relation to Disinvestment:
Alternative technologies and target population
Disinvestment of obsolete technologies depends on
obsolete definition
Non cost-effective Redundant
Obsolete definition?
What should be taken into account:
• High impact technologies? Eg: technologies with CLEAR SUBSTITUTIVE and that the change implies investment or adaptation…
• Areas in which vulnerable populations are not affected
• Start in areas that aren’t controversial or suppose low impact?
• Start in areas in which safety and effectiveness are controversial?
Methodological guidelines
obsolete technologies
context:
EuroScan)
IDENTIFICATION and ASSESSMENT
EuroScan database
Specially in prescription of drugs and variability surgical procedures and diagnostics
Identification
Ophthalmology
• More collaborative experts:
Technological frustration
Identification: things to learn from our experience
19
obsolete?
substituted by an alternative
technology
account
GuNFT guideline
the potential for disinvestment
in certain health technologies
which, for whatever reason, fail
to achieve the objective(s) for
which they were originally
Nominal Group
• Life cycle of technologies is a more appropriate concept
• Different processes are comprised
Identification of health needs
Effective implementation of technologies
Delisting or disinvestment of technologies of low-added or no added value
Initiatives currently in practice
• Horizon scanning / Early Awareness
• Early Dialogue.
Concept papers and guidances
CONCLUSIONS
• Same evidence could lead to different recommendations and actions
• HTA is needed at the three levels of decision (micro, meso and
macro) and at the three main decision moments (investment,
practice and disinvestment)
• HTA initiatives that have been focused at the macro level are not successful
• The life cycle concept of health technologies needs to be considered
• Identify the customer and feed its needs
• Importance of the combination of methods (qualitative and
quantitative) for the identification of problems and the reasons that
justified them
An aid can be the start of a promising future
For more clarifications
• Dr. Iñaki Gutiérrez-Ibarluzea
Secretary of HTAi
Research and Innovation Directorate