This presentation was made by Vadim Perman, Israel, at the 6th Meeting of the Joint OECD DELSA-GOV Network on Fiscal Sustainability of Health Systems, held at the OECD Conference Centre, Paris, on 18-19 September 2017
2. What is the scope of the National List of
Health Services (NLHS) ?
The NLHS includes:
- over 3000 pharmaceuticals
- approx. 1,100 other technologies
The Cost of NLHS –
NIS 48 billion
Israeli Pharmaceutical market -
approx 8-9 billion (NIS)
4. Technologic addition to the health basket out of total
health basket
Source: Ministry of Health data; Pharma Israel analysis. Data in graph is based on the Basket Committee available data, and excludes additional
24m NIS in 2015 (total 2015 - 324m NIS), additional 15m NIS in 2009 (total 2009 – 416m NIS), additional 60m NIS due to third addition to the
health basket (total 2008 - 510m NIS). Data also excludes budget allocated to dental care for children and elderly.
5. The scarcity problem: technologies rated A8-A9 and A9 vs.
budget for addition to the Health Basket
Source: Pharma Israel analysis
7. UPDATING THE NLHS - STEPS
submissions of applications to the MTIA
March
January
March-July
July-October
October-December
• Safety, efficiency,
literature review
• benefit, epidemiologic
assessment
• Sub-committee
• National Councils
• Medical organizations
Director-General’s Directive on
submission of technologies for the NLHS
Technology assessment of said
submissions
integration of information
National Public Committee
8. Public committee – decision making
18 members:
Chairperson
the director of the MTIA
4 Physicians
4 Economists
4 Health Funds
4 Public representatives from
the fields of medical sciences, ethics, social sciences and
welfare.
10. 10
KEY ELEMENTS IN TECHNOLOGY
INCLUSION
Budget Impact
Professional
associations
recommendation
11. DILEMMAS FROM THE PUBLIC
COMMITTEE
MUCH FOR A FEW LESS FOR MANY.
WHAT IS THE DEFINITION OF A “LIFE SAVING TECHNOLOGY”?
URGENT HEALTH NEEDS VS. INVESTMENT IN FUTURE HEALTH (PREVENTION).
WHAT SHOULD BE THE STANDPOINT OF THE COMMITTEE (HEALTH SECTOR VS.
OVERALL NATIONAL CONSIDERATIONS) ?
INCLUSION IN THE NLHS FOR A LIMITED PERIOD OF TIME.
SHOULD THE COMMITTEE LIMIT RECOMMENDATIONS TO THE BUDGET
ALLOCATED OR HIGHLIGHT HEALTH NEEDS ?
12. RISING COST OF TECHNOLOGIES – WHAT CAN
BE DONE ?
• PRICE NEGOTIATIONS
• DEFINING SPECIFIC PATIENT GROUPS WHO BENEFIT THE
MOST FROM SAID TECHNOLOGY
• LIMITATIONS – LINE OF THERAPY, CLINICAL
CHARACTERISTICS
• CLASS EFFECT
• PERFORMANCE BASED RISK SHARING SCHEMES
• CAPPING AGREEMENTS
13. In conclusion:
Israel has created a uniform nomenclature, definitions and
methodology for HTA under governmental leadership.
The mechanism is both feasible and practical for the needs of the
Israeli healthcare system and involves all stakeholders.
There is a direct link between HTA, Decision making and Budget
allocation.
The process is highly accepted by the health system, judicial
system, political system and the general public.