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9th International EBHC Symposium 2014
"HTA for Crisis"
The Symposium took place in Krakow on December 15th and 16th, 2014 in Park Inn Hotel.
With the development of medicine, the maintenance costs of health care systems are becoming a fundamental problem in Europe, North America and Australia. After decades of improving treatment methods and work time organization it is time to care about ensuring continuity of financing the extended meticulously systems, providing the needies newer technologies. Policymakers watch with concern the increasing exponentially costs that are ready to break the system and bury them all. Therefore, the concept of „fiscal discipline” and „rationalization” become subjects of publications and medical conferences, as well as debates and political medical environments.
Problems with the costs are perceived even faster – often painfully – by participants of the health system located on the side: patients, their families and loved ones. More and more groups feel aggrieved by lack of access in the system to the latest technologies, the existence of which they know very well, and they can not afford them. We are witnesses of dramatic protests of parents of children affected by the ultra-rare diseases, patients with cancer and other groups.
Patients do not have time to debate and systematic search for solutions. They demand treatment here and now, before it is too late for them. The conflict against the inability to finance all the latest technologies will continue to grow. The more advanced (and expensive) are the technologies themselves, the less methods of fighting – the struggle for life and health – for access to them become civilized.
Putting aside the emotions, it must be said that in health care, the same as in the areas of „production” when the game is about improving the performance with the limited financial resources, appears Quality.
With the great diversity and scale of costs occurring in health care savings from quality management does not appear suddenly after a correction in the key area. Real savings will be the sum of the number of amendments made continuously in each section of the process and at every level of the organization. It is like checking each section of pipe and plugging each tiny leak - is a long and tedious process.
Quality in health care is a multidimensional concept that can be understood differently by different participants. For some it is better for the other proverbial „TV set with in single room” and yet for others the use of the EBM.
Partners of 9th EBHC Symposium


  1. Jakub Adamski, Poland
  2. Ronald L. Akehurst, UK  | See abstract
  3. Małgorzata Bała, Poland  | See abstract
  4. Bacchus Barua, Canada  | See abstract
    Zobacz materiały dodatkowe polecane przez tego prelegenta:
    •  Barua and Fathers - Waiting Your Turn 2014 (2 MB)
    •  Barua - Provincial Healthcare Index 2013 (800 kB)
    •  Esmail and Walker - How Good is Canadian Health Care 2008 (1,2 MB)
    •  Globerman 2013 - Reducing wait times (1,5 MB)
    •  Skinner - Canadian Health Policy Failures (2 MB)
  5. Stefan Bogusławski, Poland
  6. Maria Boratyńska, Poland  | See abstract
  7. Aleš Bourek, Czech Republic  | See abstract
  8. Brian Godman, Sweden
  9. Jo Carol Hiatt, USA  | See abstract
  10. Maarten IJzerman, Netherlands  | See abstract
  11. Karina Jahnz-Różyk, Poland  | See abstract
  12. Katarzyna Kolasa, Poland  | See abstract
  13. Anna Kordecka, Poland
  14. Basia Kutryba, Poland  | See abstract
  15. Krzysztof Łanda, Poland  | See abstract
  16. Wojciech Matusewicz, Poland
  17. Janusz Meder, Poland
  18. Val Moore, UK  | See abstract
  19. Axel Mühlbacher, Germany  | See abstract
  20. Rafał Niżankowski, Poland
  21. Leszek Stabrawa, Poland
  22. Mitchell Sugarman, USA
  23. Rosa Sunol, Spain  | See abstract
  24. Björn Wettermark, Sweden  | See abstract
  25. Claudia Wild, Austria  | See abstract
  26. Magdalena Władysiuk, Poland


Session 1. Guidelines for HTA - developments
Health Technology Assessment guidelines were have been created to regulate the methodology and reliability of the developed and submitted HTA reports. They are used by policy makers and analysts in HTA agencies. Along with the evolution of HTA agencies, the methodology, systems and scope of required information change – and so, in consequence, the guidelines evolve as well.
During this session we want to initiate a discussion about the directions of development of guidelines for health technology assessment in Poland. Is it worth to update them or determine who should initiate the process and who should set the general direction for change every few years? Discussions held all over the world begin to focus on the mechanisms supporting reimbursement decisions and issuing recommendations. More and more attention is also paid to indirect costs and changing the approach to analyses regarding rare diseases. It is high time to decide which path Poland should take and take strong action.
One should bear in mind that the development of HTA is strongly associated with the development of EBM and the Cochrane Collaboration activity – an international non-for-profit organisation operating as a cooperation network of people involved in health care (including researchers, practitioners, patients). The organisation was founded in 1993 in response to an appeal of a British epidemiologist, Archie Cochrane. He noticed the lack of collations of results of existing randomised controlled trials in various medical specialties which would be evaluated in terms of reliability and regularly updated. The Cochrane Collaboration promotes an evidence-based decision-making process, included, among others, in systematic reviews prepared by members of the Cochrane Collaboration..The Cochrane systematic reviews evaluate the effectiveness of therapeutic, prophylactic and diagnostic interventions. Cochrane analyses cannot be financed from commercial sources. Currently, it is estimated that more than 30 000 people from 120 countries are involved in the Cochrane Collaboration activity. The Cochrane reviews are published in the Cochrane Library, which now includes more than 8 000 publications.
The Cochrane Collaboration activity in Poland has undergone various stages and it might be resumed in an extended range. This will most likely impact Polish institutions involved in health technology assessment and clinical guidelines.
Collaboration with NICE is headed in a slightly different direction -– in addition to creating HTA reports and clinical guidelines, it also includes determining quality standards in specific clinical areas. The set of NICE quality standards is being developed as a review for the areas indicated by the Ministry of Health. NICE evaluation is based on basic elements, such as population, health condition, list of key recommendations and identification of sources ensuring the desired quality of care (including social care) within the public healthcare system.

Session 2. Legacy in health care system
The problem of quality of law and the legislative process has been publically debated for many years. Demands for “good law” are commonly postulated. Law should help effectively achieve objectives, use proportionate tools and require the least resources, internally consistent, and yet clear and understandable to the average citizen. And most of all, it should not act to the detriment of the citizen. As the relations between various public and private entities and relationships extending beyond a single legal system become more complex, the need to take concrete action in this field increases.
An attempt to comprehensively (quantitatively and qualitatively) diagnose of major perpetrations of the Polish legislation was made nearly ten years. An EY report entitled „The legislative process in Poland. Legislative rules and the quality of legislation” published in mentions, among others, the following problems:
  • over-regulation – not only are the legal acts (laws and regulations) regulating various issues too numerous, but they also regulate issues which do not require it,
  • instability of the law – amending legislation with excessive frequency makes it impossible to plan activities in advance and anticipate their consequences,
  • the “sartorial nature” of law – applying too many exceptions to the general principles of law,
  • the regulations are too detailed to satisfy immediate needs.
All of these problems are present also present in the legislation related to health care, which impacts citizens particularly strongly. At the same time a closer look at the current situation reveals shortcomings in planning, preparing, implementing and controlling the effects of applicable legislation. These problems are related both to deficiencies in human resources and the imperfection of existing legislative procedures– especially with regard to consultations of drafted legal acts with experts, as well as considerable politicisation of the discussion.
This session will be devoted to an in-depth diagnosis of the problems which affect health care law, particularly those legal acts which are most problematic. Examples of solutions ensuring high quality legislation used worldwide will also be presented.

Session 3. How does funding translate into improvement. The impact of EU funded projects upon the quality developments in European Healthcare - in association with European Society for Quality in Healthcare (ESQH)
On 26 February 2014 the third Health Programme was adopted by the European Parliament and by the Council. The 2014 work programme to implement the third Health Programme has been published. And CHAFEA has launched calls for proposals for projects, with detailed information available then on the CHAFEA website. But how does this translate into a change leading to an improvement? How does this issue look lke in other EU Member States? Every improvement is a change, however not every change turns out to be an improvement.
How do we use the results, findings and recommendations resulting from EU-funded projects? Do we appreciate them, grant them political value and implement them? Or do we just celebrate the project partnership and the recognition, have a good time and ride around attractive European locations, and leave it all as soon as the project is over? Shall we redefine PBL as project based learning for the purpose of going further than a project, especially after it is completed?
The session aims at discussing the outcomes of some EU-funded initiatives: the DuQUE and HANDOVER research projects and one of the EU co-funded Joint Actions: the Joint Action on Patient Safety and Quality of Care, as well as provide an insight into management challenges of the EU-wide and quality-oriented organisation in the time of crisis – management in space and time. Hopefully leading to survival.

Session 4. Multi-criteria decision making - a new approach to decision making
There is no such thing as a perfect healthcare system which would make it possible to meet the needs of all citizens. The question of how to optimise allocation of financial resources has been a challenge for both the well developed and developing countries. Insufficient funds cause the need to chose who should be granted access to treatment and in what order.
But for such decisions to be accepted both by the patients in question and the society as a whole, it is of key importance to determine criteria which the decision makers should adopt when making choices related to allocation of funds. The criteria which are most often named are equality and social justice. The common use of cost-analyses fosters efficiency over equality and social justice in such decisions. New approaches, such as multi-criteria decision making (MCDA) aim at taking into account a wider set of criteria in the decision making process and treating each of the as significant.
The aim of this presentation will be to consider the society’s expectations towards allocation criteria, how multi-criteria decision making looks like and whether the introduction of such an approach is possible in CEE countries, where limited financial resources encourage focusing on efficiency criteria.

Session 5. Quality standards in clinical practice - paediatrics, drug programmes
While the role of paediatrics in any health care system is unquestionably crucial, for years the main component of measuring the effectiveness of the system in Poland has been infant mortality. However, during the later years, child care within the system is not systematically assessed, either in clinical terms, in terms of scientific evidence or quality, and even more so in the field of health technology assessment among children. By restricting the use of EBM in paediatrics, we can avoid many ethical dilemmas, but at the same time we unwittingly deprive paediatrics of powerful tools facilitating the decision-making process which improve the effectiveness of treatment and thus further enhance the quality of the system.
During the session we want to address the following issues:
  • What are the main problems currently unsettling the paediatric health care system?
  • What affects the level of child care?
  • How to assess the usefulness of proposals for changes in paediatric care based on the example of other countries? And how can we implement them?
  • Can we transfer the experience of care for adults to care for children?
  • What problems do we face more and more often when collecting scientific evidence relating to children?
  • A look at the European perspective on rare diseases and as well as Polish solutions and constraints in the system – seen from the angle of clinical aspects, care organisations, communication with the industry.
In addition to these issues, we will particularly focus on taking reimbursement decisions and developing economic analyses based on clinical trials on children.

Session 6. Aspects of quality in oncology care
If you follows the situation in Poland, you can easily be under the impression that no one cares about the sick people. Despite several exciting announcements in the media, exalted campaign titles and numerous expert analyses done „by the sweat of the brow”, the system is becoming less and less patient-friendly. Unfortunately, the facts demonstrate that the question „Is it worth to care for the patients” still meets with a negative response. Recently there has been ongoing feverish work to improve the functioning of the oncological care in Poland, and the queues for these benefits have become the go-to media topic. Can we actually believe starting 1st January 2015 something will change for the better? If seriously approached, this reform would meet two minimal conditions:
  1. Proposals for changes in the system would be based on a feasibility study.
  2. Indication of funding sources. Each reform costs, and National Health Fund protects itself against insolvency by introducing limits on the amount of provided health services. So it is clear that eliminating them in oncology will inevitably increase expenditure.
Neither the first nor the second condition has been met – no feasibility study has been published, nor have the sources of additional funding been indicated. The quality of cancer care is on the everyone’s mouths: the government, political parties, civil servants, doctors, nurses, pharmacists, hospital directors and manufacturers. And very rightly so, as just like good accessibility of health services, it is quality that patients care about the most. Somehow, however, we have failed to achieve this quality for years now. What is worse – Poland fails to even measure or monitor it. We only know that our health care system has been judged by the society very negatively for years, and Poland looks unfavorably in comparison to other OECD countries. Empty promises and declarations do not translate into practical solutions. Why?
  1. First, in Poland everyone knows about medicine. But „qualitics” is a special science and you have to be a professional to be familiar with systems and tools applied to ensure quality in health care.
  2. Second, in order to know where to go, you need to know your current position. To see what is actually happening in the health care system you must have an electronic data collection system, the so-called RUM (Register of Medical Services). We remember the pompous announcement in 2007 that the RUM will be launched in Poland by 2012. It is already 2014, and the government once again postponed its introduction until 2017. This time the problem seems to be something else then money, which was given to us in excess for this purpose by the European Union. So what is the problem? Maybe someone does not wish for such a system to be created at all, or wants to postpone setting it up as long as possible? But does anyone else, apart from patients, really cares for the implementation of an efficient Register of Medical Services?
  3. Third, many decision-makers know that ensuring quality in the system costs a lot, but few of them are aware that lack of monitoring of the quality and using pro-quality tools costs even more. Expenditure related to “qualitics” should be treated as a necessary investment, not costly extravagance. A feasibility study and measurement of the return on investment must be done a priori for each such investment – regarding both savings and health effects. In Poland, no such analyses are performed.
During the session the following issues will be discussed:
  1. Providing adequate resources for a quality assurance system
  2. Improving the accreditation system
  3. Guidelines and standards
  4. Education of the personel
  5. Registries kept in accordance with Good Registry Practice
  6. Registry of Medical Services (RUM)
  7. Coordination of care and multidisciplinary teams
  8. Changing the role of hospital ward heads
  9. Improving standards of technical safety certification
  10. „Money follows the patient” – financing benefits of the first and second reference level, not the database
  11. Creating rankings of branches

Session 7. Quality assurance in system – indicator, databases and other tools
The quality of health care can be seen from different perspectives – as the sum of quality of individual services provided to patients in various institutions (hospitals, clinics and other facilities). Quality can be assessed in terms of the quality of the structure, quality of processes and quality of results, but also from different perspectives – the patient, the tax payer, the doctor.
The quality of structure can be assessed both by the clinician and the payer. The quality of processes and results is assessed by specific stakeholders, especially in terms of smoothness, complexity and proper reaction time. There is a very wide range of tools, but it is crucial to choose them appropriately for the data that we have. Assessment of the quality of results can be carried out by comparing single units which are similar to each other (within the benchmark) or larger structures of the system. The quality of clinical results and efficiency of actions are being continuously improved in many systems, including the assessment of patient satisfaction. The Deming cycle can be used for all processes in organisations or systems:
  • Plan – establish objectives for each process,
  • Do – implement the planned processes,
  • Check – monitor and measure the relevant parameters of the processes,
  • Act – improve the processes constantly.
During this session we want to consider the tools used in assessing the quality of e.g. doctors’ prescriptions in the system, the use of databases and data analyses.


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