8th strategic Value of Innovation ConferenceDevelopment in the 21st century - Time for ambition
Ljubljana, 19 November 2019 – It’s time for ambition, agreed the participants of the 8th Value of Innovation Strategic Conference: Challenges of health and Development in the 21st Century. Healthcare systems need modernization to appropriately address the needs of patients for effective and accessible healthcare and tackle challenges brought about by demographic changes, increases in chronic non-infectious diseases, advances in science and patient adapted medicine. A development oriented healthcare system and appropriate access to innovations can only be achieved by introducing integrated evaluation of healthcare technologies and new new medicines that takes into account the costs as well as the direct and indirect effects that occur within and outside the healthcare system. Integrated evaluation of innovations assists the healthcare service payer in deciding on spending and assuring the necessary transparency and responsibility of all stakeholders in healthcare. Systemic measures towards modernization of the healthcare system should be planned and directed by the Ministry of Health in cooperation with all stakeholders in healthcare.
Lecturers and guests at the 8th Value of Innovation Strategic Conference: Challenges of health and Development in the 21st Century - Time For Ambition, which was organized by the Forum of International Research and Development Pharmaceutical Companies, EIG, and took place at the Health Insurance Institute of Slovenia, emphasized the importance of modernization of the healthcare system. Aging of the population and increases in chronic non-infectious diseases that are responsible for premature mortality and up to 80 percent of all deaths, pose a great challenge for individuals and society and a great financial burden for healthcare. The Director General of the Public Health Directorate at the Ministry of Health Mojca Gobec presented measures to reduce the burden of chronic non infectious disease:
“Over the past decades Slovenia has achieved a substantial extension of life expectancy and reduction of mortality due to cardiovascular disease. Screening tests for early discovery of cervical cancer (ZORA), breast cancer (DORA) and colorectal cancer (SVIT) have reduced the incidence of these cancers and extended survival rates. The healthcare system is adapting to changes and needs of a rapidly aging population and increasing numbers of people with chronic conditions. Investments in health strengthening and disease prevention programs and the maintenance and strengthening of the primary healthcare system with the introduction of integrated care are among the most important measures we can use to manage the burden of chronic disease. Another important development in Slovenia in recent years has been the direction of healthcare towards strengthening health and preventing chronic diseases. We are actively discovering persons with risk factors and directing them as necessary towards health strengthening centers to receive necessary expert support in introducing changes, counseling and assistance. These services are intended and adapted to vulnerable population groups in order to reduce inequalities in healthcare.”
Effective and modern healthcare and equality in health cannot be imagined without good access to innovative medicines which is satisfactory in Slovenia due to constructive cooperation and constant negotiations between the pharmaceutical industry and the Health Insurance Institute of Slovenia and cooperation with other stakeholders in healthcare. General Director of the Health Insurance Institute of Slovenia Marjan Sušelj assured that the Institute will continue to strive for good access to new medicines within its capabilities:
“In spite of modest financial possibilities in 2020, determined by the Decree of the National Assembly of the Republic of Slovenia on maximum allowed public healthcare budget spending, the Health Insurance Institute of Slovenia will continue to strive to maintain the achieved high level of access to (new) medicines for insured Slovenians. With successful introduction of new mechanisms for managing expenditures for medicines and concurrent promotion of development in diagnostics and treatments we have reason to look towards the future with optimism. We also expect constructive and development focused cooperation of the pharmaceutical industry, such as agreements for individual medicines and systemic agreements and regimes of compassionate use in new medicines.”
Secretary General of the Forum of International Research and Development Pharmaceutical Companies, EIG, mag. Barbara Stegel believes innovative medicines and new technologies are essential for the improvement of health indicators and maintaining a focus on development in the healthcare system:
“We are seeking to assure that investments into innovative medicines are considered holistically and assessed together with their social impact and savings they bring both within and outside the healthcare system because good access to medicines is a key prerequisite for a successful healthcare system. The introduction of new medicines is the most regulated field in healthcare and the share of expenditures for medicines as of 2010 amounts to only 15 percent of all expenditures of the Health Insurance Institute of Slovenia. In the future we will continue to assure that innovations be given an appropriate place and at least an equal share of finances within the Insurance Institute budget. After all, it is a fact that societies that used more developed technologies always proved to be more advanced. And companies that use new technologies continue to have the edge on their competitors in modern times.”
Assurance of quality healthcare will become more demanding in the future due to population aging so the introduction of a special healthcare technology assessment tool (HTA) is a prerequisite for a sustainable healthcare system. The development of HTA at the European level was explained by Dr. Andrej Janžič from the Public Agency for Medicinal Products and Medical devices:
“Regulation in this field is within the competence of each individual state as it bears upon healthcare systems and decisions on financing certain products and services or the basket of rights patients are entitled to. Consequentially there are substantial differences between countries in the EU in their organization and development of HTA in connection with the decision making system for financing. There are differences in capacity and competence and the associated level of assessment and grading of healthcare technologies. The EU area is currently holding discussions on a common assessment program which is only partial and includes the clinical aspect. But there are different views already at this level and EU members have yet to find a common language. It is therefore too early to say how this field will be regulated at EU level. It is, however, quite certain that at least a part of the procedure and the final assessment will remain at a national level and it is up to each individual country to define and develop its HTA system within the wider context of its healthcare system.”
Advances in science are fierce. The paradigm of medical treatment is shifting and we are entering an era of personalized medicine and digitalization for which Slovenia is ill prepared, finds associate professor Dr. Petra Došenovič Bonča from the Faculty of Economics at the University of Ljubljana:
“These trends will bring a shift from diagnosing and treating disease to forecasting disease and life-long patient management, new types of service providers, different work processes and specialization of service providers. For the sake of efficiency, quality and safety specialization will also require a transnational development of service provider networks. Challenges in assuring financial sustainability of public healthcare systems will strengthen and new opportunities for commercialization will arise. In order to maintain stable public healthcare systems the introduction of economic assessment of healthcare technologies will play a major role in terms of evidence based allocation of resources among different programs, long term planning of human and material capacities, new models of paying service providers that promote cost efficiency while assuring quality and organizational innovations in addition to technological ones.”
Dr. Došenović Bonča also spoke about focus on development in the Slovenian healthcare system:
“When deciding on the basket the Health Insurance Institute of Slovenia must on the one hand observe its budgetary limitations in the form of funds collected through contributions. On the other hand the structure of the basket should be decided transparently and with due diligence. This means that the limited available to healthcare must be allocated to those programs, services, medicines and other technologies that provide the best effect in comparison to the investment. But both the costs and effects must be assessed from the viewpoints of all relevant stakeholders who collectively finance healthcare precisely so that the Health Insurance Institute of Slovenia would achieve a socially acceptable level of healthcare goods instead of the market just running its course.
The concept of healthcare that includes not only assessments of direct expenditures but also the long term value for patients, society and the healthcare system itself as a foundation for an effective and development focused healthcare management was presented by management and health economics specialist, Director of Health Technology Management at Luz Saúde in Portugal, Mr. Francisco Nuno Rocha-Goncalves:
“The first step I would advise to a healthcare system on its way to establishing value based health care is to pursue a thorough analysis of clinical pathways taken by patients in each separate hospital. On the basis of an analysis of data collected from clinical practice a group of experts can establish the actual outcomes and results of treatment and create a plan of necessary changes within each hospital. The next step is to carry out simulations of these outcomes with access to additional resources, other ways of financing, newer technologies and suchlike. This helps create a framework for successful value based treatment.”
The expert also emphasized the need to establish a patient centric approach that must be followed by the entire system organization.
Slovenian patients and their families who need and legitimately require progress in science the most deserve a modernization of the healthcare system that will successfully address the challenges of health and development in the 21st century with the partner cooperation of all stakeholders in healthcare. It is time for ambition.
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