HTA in Austria

Ekonomika zdravotnictví, standardy kvality zdravotní péče a HTA, PrahaMay 6, 2010

Organigramm

ÖBIG Forschungs und Planungsgesellschaft mbH (non profit) ÖBIG Beratungs GmbH (for profit)

Tochtergesellschaften:

ÖBIG – Österreichisches Bundesinstitut für Gesundheitswesen

Prävention

Gesundheitsberichterstattung

Gesundheitsplanung

Gesundheitsberufe

Gesundheitsökonomie

Transplantations und Transfusionswesen

Alten , Langzeit und Psychosoziale Versorgung

Dr. Arno Melitopulos

BIQG – Bundesinstitut für Qualitätim Gesundheitswesen

Struktur und Prozessqualität

Qualitätsregister und Ergebnisqualität

Qualitätsberichte und Gesundheitsinformation

Qualität und Wirtschaftlichkeit

Eva Maria Baumer, MPH

FGÖ – Fonds Gesundes Österreich

Projektförderung und entwicklung für Gesundheitsförderung

Qualitätsentwicklung und Fördermanagement

Fort und Weiterbildung,(Inter )Nationale Vernetzung

Information und Aufklärung

Selbsthilfe (SIGIS)

Mag. Christoph Hörhan

Gesundheit Österreich GmbH / Dr. Arno Melitopulos

HTA in Austria – presentation outline

Features of the Austrian health care system

Barriers for evidence based decision making

From eminence to evidence ? – a national HTA strategy for Austria

aims

current status

examples of impact

challenges.

Features of the Austrian Health Care System

social health insurance (98% of population covered)

federal structure

delegation of competencies (planning, coordinating, financing)

to self-governing stakeholders in the social insurance

to cross-stakeholder assemblies at federal and provinces levels

fragmentation

Out-patient sector: regulatory responsibilities at federal government, directly financed by social insurance

In-patient sector: implementation and enforcement at 9 provinces, financed by social insurance and taxes bias toward hospital care

Out-patient and rehabilitation: organized by negotiations between health insurance funds & chambers of physicians and pharmacists.

Federal administration

Ministry of Health

regional administrations

Out-

patients

In-

doctors/-chambersother health professionals

Federation of Social security Funds

Federal health commission

Social Insurance Funds

Serv

ice

nego

tiatio

ns

Contracts on implementation competence shift

Serv

ice

nego

tiatio

ns

Regional „Health Platforms“

hospitals/hospital carriers

Attempts to Reform the Health Care System

deal with cost containment and structural reforms

efforts toward decision-making and financing

effective across all levels and

more evidence based

linkage of quality assurance in decision making to HTA and EbM (Federal Law for establishing Quality in Health Care 2006).

How the Health Care System can benefit from HTA

HTA

provides rational decision support

rationalizes negotiations

helps to resist lobbying

helps to increase quality in health care

does not absolve politicians from decision making (based on ethic, social, demographic and allocation fairness aspects)

Aims of a national Austrian HTA strategy

Optimize decision making in the health care system on general levelby the use of scientific instruments

increase knowledge and acceptance to force commitment

make HTA obligatory and binding in decision-making process

provide for financial and personal resources

control quality in HTA production by common methods and standards

avoid duplication and use synergies (national networks, peer groups, International co-operations )

disseminate results: HTA information to all interested stakeholders

specialist advice and co-operation

clearing house, information platform

Ministry of Health

UAG Qualität

Fed agency of health

development, implementation and

factual control HTA work groupFed. state / provinces /

sozial insurance

National HTA Strategy

Gesundheit Österreich Federal institute for quality in

health care system

HTA expert poolfrom Austrian and

German HTA organisations

Current activities within the national HTA strategy

nationwide standards for methods and processes

harmonised peer review process

public topic selection and prioritization process as a pilot http://www.goeg.at/de/Bereich/HTA-Themenfindung.html

seminar series for stakeholders

national HTA-register of completed, ongoing and planned reports, integrated into a European meta search engine

annual HTA-symposia

freely accessible electronic guide to international HTA information and ressources http://hta-guide.biqg.at

EBM Review Center – Med UNI Graz

GÖG/BIQG

Department for evidence based medicine

Donau UNI Kremse.g. for IQWiG

e.g. for AHRQ

e.g. for DIMDI

First Austrian HTA-Symposium on May 3rd 2010

Current impact of HTA in Austria: non-systematic

Examples

investigational in-patient services (“MELs”) applied for the health service basket – Federal Health Agency

horizon scanning on emerging cancer drugs – MoH + hospital carriers

deficiency concerning para-medical professions - MoH

prevention programs: e.g. HPV immunisation - MoH

screening tests: HIV test for pregnant - MoH

out-patient cardiovascular rehabilitation (phase III) - social insurance

provision planning of positron emission tomography - hospital carrier

Which aspects are currently applied in Austria

effectiveness

additional benefit

Alternatives

increasing quality in health care

no thresholds (benefit – harm)

no economic criteria (no cost saving reasons (yet), no allocation alternativs)

no procedure for disinvestment issues

not used for regulation mechanism for future research

Crucial Issues to achieve a vital national HTA-strategy

We still need

agreement on transparent decision making at the key stakeholders

systematic use of the methods: sticking to the process, using the results

formally integration into decision making processes

assured adequate financing.

Where am I?

You’re 30 metres above

the ground in a balloon

You must be a researcher

Yes. How did you know?

Because what you told me is

absolutely correct but completely

useless

You must be a policy maker

Yes, how did you know?

Because you don’t know where you are, you don’t know where you’re going, and now

you’re blaming me

The problem

MMag. Elisabeth Breyer

Stubenring 6

1010 Wien, Österreich

T: 1234567-112

F: 12345678

E: elisabeth.breyer@goeg.at

www.goeg.at

Contact