If the pandemic has revealed anything, it is the health system’s weaknesses. The lack of technologies, protective equipment, production capacity, shortage problems; the collapse of primary care due to the lack of resources and professionals in ICUs; the vulnerability of tracking and surveillance structures to contain the epidemic; the lack of coordination between autonomous communities, which has led to a slow and heterogeneous response, and the lack of prevention strategies and long-term planning are some of them. But what to do and how to improve management at a critical time?
In December, more than 300 clinicians, academics, economists and lawyers published a manifesto proposing the creation of an independent institution to evaluate health benefits. That is, a government agency of organic status that assesses and recommends access to the system of new drugs, medical devices, diagnostic tests and tests, technologies and surgical procedures, following a cost-effectiveness analysis by a committee of multidisciplinary experts – specialists, biostatists, health economists, ethicists, patient organizations, epidemiologists, pharmacologists – say Ruth Puig Peiró and Pilar Pinilla Domínguez, respectively, vice president and member of the Health Economics Association (AES), an entity that staged another debate in February. It would be like an Airef, but hygienic, they illustrate.
The idea is that you evaluate the cost-effectiveness of all health services, from medicines to medical devices
“In Spain, health management and financing are much more politicized. The decision-making takes place from the ministry [de Sanidad], there is no protection, no guarantees to minimize such interference, nor a homogeneous system, which can create inequalities in access and a significant lack of coordination, ”said Puig, who worked at the Catalan health service (CatSalut).
The country has Spain’s network of health technology and benefits assessment agencies (Redets), but it doesn’t research the cost of drugs, Pinilla says, which is done through RevalMed. “These agencies exist at the regional level, they are managed as best as possible and are highly dependent on the political management of the moment,” added Puig. They therefore propose the creation of a HispaNice, following the British model, the National Institute for Health and Care Excellence (Nice), which has been operating since 1999 and whose recommendations are legally binding. In Germany, France, USA, Canada or Australia, the suggestions of these agencies are not.
The economist behind the document, Guillem López Casasnovas, professor at Pompeu Fabra University (UPF) and also a member of AES, urges us to work in two areas: rationalizing current spending and prioritizing the future. “What has grown by double digits in recent years is hospital drug spending because of the poorly resolved tension between the hospital pharmacy and the clinicians. It has not been rationalized which is the best option and which is subject to follow-up by the rest of the centers, ”he emphasizes.
And with regard to future expenditures, he adds, “Someone needs to see if the incremental benefit of the new technology, drug or indication over the existing one matches the additional cost.” López is in favor of copying the American ICER (Institute for Clinical and Economic Review), aimed at the analysis of effectiveness. “It requires fewer people, you can use the existing network of agencies and you just need to pass a law that protects these actions,” he defends. The investment (not calculated) would be made with European funds and would be self-financed at the rates charged by the industry for its services.
For the employer of Farmaindustria “the economic evaluation is necessary in the pricing and financing process of new medicines and it is up to the state to decide who will implement them. The most important thing is that it is done according to an objective, transparent, participative and agile procedure ”.
Digitization, another challenge
The digitization of the healthcare system is essential for the integration of personalized precision medicine and for achieving patient-centered preventive, diagnostic and therapeutic care. This is stated in a recent report published by the Roche Institute Foundation, which contains 50 recommendations in five areas to speed up implementation, improve management and reduce costs.
The document, which is in charge of a group of specialists and experts from various fields, proposes the need to promote technological innovation, have an interconnected infrastructure and establish measures that ensure governance and regulation under the values of bio- ethics.
In addition to ensuring the organization, standardization and interoperability of data, its security and improving the training of health professionals, managers and actors of the system. This, according to the report, will benefit a model for preventive care, public health, biomedical research, management and patient participation in decision-making.