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7th International EBHC Symposium 2012
"HTA for Crisis"
The Symposium took place in Krakow on October 8th and 9th, 2012 in Park Inn Hotel.
The seventh EBHC Symposium is an extraordinary educational initiative for participants from Poland and other Central and Eastern European countries. It is yet another time we would like to provide an opportunity to meet experts from all around the world, a free opinion exchange with ministry delegates, insurers, payers, and European medical and business representatives. The Symposium provides an opportunity to submit abstracts, thus creating a forum for the presentation of personal experience, projects and views on HTA in Europe, and especially in the CEE region.
This year’s theme: "HTA for Crisis" reflects the most current European and international concerns. Discarding the traditional perception of crisis as a solely negative phenomenon, we would like to focus on seeking the inspirational aspects of this unfortunate economic situation. Are the greatest changes not born through revolution? Does hard practice not make master? Is a dire and dramatic resource limitation not a time for proving rationalization effective and justified?

The scientific program of the Symposium was presented over two days in five main thematic sessions:
  1. Insurance in times of crisis
  2. The importance of pricing of health services in times of crisis
  3. Managing welfare benefits in times of crisis
  4. HTA in crisis-laden countries
  5. Between the devil and the deep blue sea? The diversity of approaches to healthcare management at times of crisis

  • Stefan Bogusławski, Poland
  • Sophie Cros, Belgium
  • Jurij Furst, Slovenia
  • Kristina Garuoliene, Lithuania
  • Brian Godman, UK
  • Jacek Graliński, Poland
  • Iñaki Gutiérrez-Ibarluzea, Spain (Basque Region)
  • Alan Haycox, UK
  • Chris Henshall, UK
  • Roger James, UK
  • Jan Jones, UK
  • Joanna Lis, Poland
  • Krzysztof Łanda, Poland
  • Jarosław Oleszczuk, Poland
  • Mitch Sugarman, USA
  • Adam Śliwiński, Poland
  • Mel Walker, UK
  • Magdalena Władysiuk, Poland

1. Insurance in times of crisis
The deficit, or the disproportion between the amount of resources and the contents of the benefit package, is the main illness affecting the healthcare system. The society, however, does not feel ill, but experiences all the symptoms, leading to numerous, dramatic consequences (long queues, corruption, off-the-record self-assigned doctors’ benefits). The greater the deficit the more unfair the system is, and the more pathology it reflects. A healthcare system can be neither effective nor just until the benefit package contains more medical technologies than it is possible to support financially by taxpayers. The currently functioning Polish system is insolvent, and the queues are more numerous and longer, stretching beyond the horizon of reason. The rationing of welfare benefits, even the basic ones – cheap and effective (with low-cost, high effectiveness ratio) – is omnipresent.
The development of complementary health insurance is the best way of dealing with the disproportion between the guaranteed benefit package and the public resources spent on healthcare. Introducing this type of insurance would lead to achieving several goals at a time, namely:
  • improve the use of private resources spent on healthcare,
  • provide the possibility to choose an additional, complementary insurance scheme,
  • introduce competitive schemes in the payer area, and incent competition between service providers,
  • eliminate or limit the grey economy in healthcare sector,
  • increase the access to health benefits in the guaranteed package (drastically limit the “queues” for services, corruption and privileges/benefits among health-care agents.
Seeing the main change trends in healthcare systems throughout the world (ageing societies, medicine developing, and more new medical technologies, limited basic taxpayer resources, and economic crisis, the increase in public demand for healthcare, etc.), one can conclude that the disproportion between the guaranteed benefit package and financial capacity of the basic health insurance is more than visible in many countries, and is bound to extend in the years to come. It seems that the introduction of complementary insurance will play a key role in shaping the future. During the session, experts will present simulations and predictions, and share their experience in the development of additional health insurance in the world.
2. The importance of pricing of health services in times of crisis
The well-known slogan: No matter how much money you pump in, any given health care system will soak it up, becomes even more relevant in the age of looming economic crisis.
On the one hand we are dealing with the ethical duty of doctors to follow the current state of knowledge, and the growing awareness of patients about the latest breakthroughs in medicine. Not to be ignored is also a fact that the society more frequently demands a just access to health benefits, as promised by the politicians; patients want to believe that their tax money is also reliably allocated in the public health care system.
On the other hand, many governments are striving (or should, at least) to persuade the public that the patient is the most important and are trying to provide a stable, well-operating health care system, based on the available resources. The pricing of health care benefits is one of the factors affecting the balance (or lack thereof) between the two perspectives.
During the session we will try to dwell on the following aspects: Internationally, are there any model examples of reactions to the changing health care needs with more and more limited resources? What conditions are needed for the sensibly managed service pricing to provide acceptable health care standards? What is, and what should be the role of all stakeholders in this process? What determines just and fair pricing for health benefits and services?
3. Managing welfare benefits in times of crisis
Growing budget limitations, increased spending on new (and more expensive) medical technologies – those are the most common quotations from all publications devoted to health care costs and management. The combination of the two phenomena with the looming economic crisis leads to much stricter criteria for including new technologies in the welfare benefit package, a harsh financial discipline, changes in medical procedures to boost efficiency, and to drastic changes in funding medical technologies (disinvestment).
Disinvestment is a broad term which not only means the removal of elements from the benefit package but also making resources available for new technologies. Disinvestment is a relatively new term, more frequently used in the decision-making process. It is carried out in accordance with the methodology of medical technology evaluation.
The following are main reasons for changes in health care investments, and they are directly related to priority setting:
  • safety issues (high risk of unwanted effects, occasional evidence for harmful effects, which are the vigilance systems domain),
  • lack of evidence for successful treatments, or only slight positive effects
  • technologies “growing old” and being pushed from the market,
  • no profitability.
During session 3 we will try to answer the following questions: “How is the disinvestment process implemented in different countries?”, “How should it be correlated with priority setting, and what aspects should be considered?”, “Is the spending estimation within the system realistic?”, “What groups of stakeholders should take part in the decision-making process?”, “Is it a simple process and what political, social, and financial problems may the decision-makers face?”, “How much does it cost to make such decisions?”
4. HTA in crisis-laden countries
We are certain that HTA’s role is bound to get more important in times of crisis. Why? The answer is the dire need of an improved management of the welfare benefit package in countries struggling with deficit. The removal of certain medical technologies and the introduction of innovative ones is imminent. In either case, only HTA ensures clarity and sensibility in decision-making.
The role of HTA shall also become more important in the pricing area, that is when it comes to setting prices and risk-division instruments, because those areas also require research-based evidence for making the right decisions. The evaluation of medical technologies will be the key element in this issue.
The financial deficit in relation to the guaranteed benefits package may initiate the development of new health insurance systems with complimentary policies, resulting in HTA’s reports becoming a basis for policy risk-calculation.
Governments in crisis-struggling countries will aim at cutting the costs of welfare benefit package management. In order to do that they will reach for an effective and cost-attractive, light HTA agency model, providing more efficiency in health and welfare offices and departments.
Soon we shall witness the rise of light HTA agencies in countries which have never had them before, or even the restructuring (or at least slowly evolving) of bulky, ineffective agencies into lighter ones.
HTA will also quickly develop in relation to service-providers because the deficit is reflected in the condition of hospitals. Special committees will have to decide, based on HTA’s analyses, upon the hospital formularies, procedure lists, and guidelines for purchasing equipment.
HTA can be useful in one more respect in crisis-laden countries: for evaluating highly-effective basic deficit benefits. Cooperating with HTA, a regulatory agency may adjust the pricing of such benefits in order to improve their availability and supply.
Have the above-mentioned processes occurred yet? We shall ask our experts and guests from crisis-laden countries about that during session 4.
5. Between the devil and the deep blue sea? The diversity of approaches to healthcare management at times of crisis
In times of crisis there is seldom an easy path to follow. Instead decision-makers are often faced with unenviable choices, few more significant than the best way to allocate scarce public health resources. But what can be done? In times of crisis HTA becomes a crucial factor in allocating increasingly limited public health resources. Our approach in the UK is to share the pain evenly by using HTA to make difficult prioritisation decisions whilst maintaining the principle of equal access to patients of equal need.
Two opposing approaches to health care are presented and debated in light of their suitability in responding to crisis in Central and Eastern Europe. This will be supplemented by brief examples of successful approaches among Central and Eastern European countries as well as others across Europe – some of whom will be expanded upon during the symposium.


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