Disaster Health Management & Risk Reduction (DHMR-1) Overview of - - PowerPoint PPT Presentation
Disaster Health Management & Risk Reduction (DHMR-1) Overview of Health T echnology Assessment in IRAN Lessons for the EMR region Ali Ak Al Akbari-Sa Sari, M MD, Ph PhD Dean, n, School hool of of Publ ublic Health Teh ehran an U
Disaster Health Management & Risk Reduction (DHMR-1)
Disaster Health Management & Risk Reduction (DHMR-1)
Dean, n, School hool of
ublic Health Teh ehran an U Univer ersity of M Med edical al Scien ences es 7th
th WHS Regi
giona
ng 2019 2019 Kish, , I.R I.R. . of Ir Iran; 29 29 to 30 30 April il 2019 2019 ak akbar arisar ari@tums.ac ac.ir
Disaster Health Management & Risk Reduction (DHMR-1)
Development of HTA system in Iran Challenges of Iran HTA system Iran health system characteristics Major characteristics of the region Main message – implications for HTA in EMR region
Establishment of formal structure for HTA under supervision of Deputy of Treatment (2010), and expansion of this office to provinces (universities of medical sciences) under supervision of Deputy of Treatment
HTA MSc program in 4 universities MSc in Health Economics in 10 universities PhD in Health Economics in 3 universities PhD in Pharmaco-economics Short time training programs including workshops on HTA,
Other training programs related to HTA e.g. epidemiology,
Following formal establishment of HTA structure in 2010, a
A proportion of NIHR budget is spent for funding HTA projects A proportion of medical university research budgets (e.g. for
HTA project receive budget also from other resources including
HTA reflected in Supreme Leader Macro Health Policies › … improved decision-making based on sound scientific findings via development of standards and clinical practice guidelines, health technology assessment, … HTA emphasized in Health Evolution Plan and other national
Mutual agreements with Office of Medical Equipment and NIHR
Develop localized HTA CoreModel framework
›
in two categories (medical interventions and diagnostics devices)
›
and three levels (Snapshot, Rapid Review, Full HTA)
Stakeholder Analysis in HTA Decision Making Process and their role Estimate Cost-Effectiveness Threshold Value for IRAN Estimate Population-Based Preference Weights for Health States for
Priority-setting of health technology assessment topics Develop Decision support system for linking HTA to policy
HTA reports on new technologies (over 120)
A
HTA seem seem s s t o have e very lim it ed im pact on decision m aking …. w hy hy? ?
Wea eak gover ernance: e:
› HTA com po ponent s com pl plet e t e but very fragm ent ed › e.g. se several HTA offi ffice ces s in MOH, F FDO, i insu surance ce organizat ions, s, … … › e.g.
HTA fundi ding bo g bodies e. e.g. P PEN I nsulin ex exper erien ence e › Dupl plicat e pr proj e j ect s t s and effort s t s pot ent ia ially lly leading t o g t o di different de t decisions
Rules es and reg egulat ions s ver ery lim it ed ed and not ef effec ect ivel ely in place e , and available regulat ions usually volunt arily
Even en w it h presen esence e of reg egulat ions, s, hea ealt h sy syst st em em gen ener erally unreg egulat ed ed
› Deci cisi sions s m ade w it hout u usi sing t t he resu sult s o s of f HTAs s › Use of HTA appr pproved d t echnologi gies for ot h t her pu purpo poses e.g .g. P . PET s scan
Large e num ber er of t ec echnologies es in place e
Rapid dev evel elopm en ent of new ew t ec echnologies es
Full HTAs s are e t im e e and reso esource e consu sum ing
Policy m akers norm ally in rush not w ait ing for t he HTA result s
Lim it ed capacit y, know led edge e and sk skills; s; and not used sed ef efficien ent ly
› e.g. profi fici ciency cy of M f MSc g c gradat es s in HTA? › Capa pacit y t y f for lim it e t ed n d num be ber o
proj e j ect s t s › Leadi ding g t o t o s significant de delay in H HTA pr proj e j ect s › Qualit y t y of HTAs and d t h t heir repo port s t s?
Lim it ed ed fragm en ent ed ed funds s
Technical problem s w it h HTA process ess › Sign gnificant de delay in fundi ding, g, cont ract ing, g, pr propo posal appr pproval, repo port appr pproval, …
HTA TA resu esult s s norm ally n not used sed and im plem em en ent ed ed by policy m aker ers s
Monit oring sy syst st em em s s e. e.g. HI S inef efficien ent (e. e.g. use se of t t ec echnology for o
er gr groups ps)
HTA TA not linked ed t o ben enef efit package e and UHC
Even a co com prehensive co com plet e effici cient HTA syst em is not enough w it hout ot her effici cient syst em s in place ce: e.g.
› pa paym ent syst e t em , › regio ionaliz lizat io ion, supply ly lim lim it it , › fa fam ily physi sici cian, refe ferral sy syst st em , › elect ct ronic c reco cords, s, H HI S, › gu guidelines, pr prot o t ocols, st anda dards ds, po policy br briefs, … … › Monit oring and evaluat ions › and ot her co cost st co cont ainm ent and co cost st co cont rol m ech chanism sm s s … … › E.g. i insu surance ce co coverage of P f PEN I nsu sulin › Ordering PEN I nsu sulin by GPs s and sp speci cialist st s s
Insurance coverage very high (about 95%), but via fragmented insurance
Wide health benefit package includes almost all services Insufficient and unstable financial resources (e.g. 34 of 40 million insured by
IRAN health insurance organization dependent on government budget)
Health system fragmented and unregulated Payment system dominantly FFS Family physician not fully implemented, no referral system HIS not efficient, human resources not enough Dual practice high High induced demand and inappropriate use of services High Inefficiency
Significant variations and diversities Transitional health, health system, economy, politics, … Significant uncertainties Instability, unrests, wars, conflicts, sanctions Natural disasters high Oil dependent economy (not sustainable) Limited resources, capacity, expertise, … HTA formal national structure in 2 EMR countries
More important Urgent need for expansion and improvement More restrictions More prioritization e.g. more expensive more costly technologies Affordability and CE e.g. hepatitis C treatment in IRAN, Pakistan, …
Disaster Health Management & Risk Reduction (DHMR-1)