Unit 1

According to ___, ___ is a state of complete physical, mental, and social well-being and not merely the ___.

WHO

health

absence of disease or infirmity

what is health?

It means different things to different people

no longer refers merely to the sum of the health of individuals

___ generally measure health and the performance of health systems in terms of ___

Health system decision makers

goodness and fairness

means a health system responding well to what people expect of it

Goodness

responds equally well to everyone, without discrimination

Fairness

Health systems differ between ___ and sometimes between ___. Health systems seek to deliver high-quality health services to their members (or population). Some health systems:

countries

regions within countries

❖ provide hospital services only

❖ provide community and primary care

❖ are responsible for prevention of disease and promotion of health.

In every health system in the world, ___ play a key role. However, their roles of are not all the same. In some cases, for instance, their role is only to ___ that govern the system which is provided by ___. In other cases, governments may ___ and ___ of health services.

governments

create the legal rules

independent bodies

fund the health system

organise the delivery

___ for health systems differ substantially. For instance, some systems are funded through ___, while others are ___. ___ by the individuals may or may not be included.

Funding structures

taxes

insurance-based schemes

Co-payments

While it is common to speak of ___, these descriptions may be misleadingly simple. For instance, a ___ (paid for by the public through taxes or social insurance such as in the UK) may in fact rely on ___ (such as for-profit or not-for-profit institutions and providers funded by investors or charitable donations) to deliver services.

public, private, and mixed systems

publicly-financed system

non-public entities

___ can be defined as the application of a branch of knowledge for practical purposes.

Technology

___ can therefore be defined as any ‘intervention that may be used to promote health, prevent, diagnose or treat disease, or for rehabilitation or long-term care. This includes ___ used in health care.

Health technology

pharmaceuticals, devices, procedures, and organisational systems

The term ‘health technology’, therefore, can be used to refer to many different interventions in a healthcare system. Examples include:

❖ Programmes to prevent ill-health (for example, childhood vaccination programmes)

❖ Procedures (such as surgery)

❖ Medicines

❖ Devices (equipment or machinery that deliver healthcare interventions or assist with

activities of daily living, such as an insulin pump or an epinephrine auto-injector)

form of policy research that examines the short- and long-term consequences of using a health technology. It is a multidisciplinary process that attempts to summarise information about the medical, social, economic, and ethical issues related to the use of a health technology. It aims to do this in a systematic, transparent, unbiased, robust manner.

Health Technology Assessment (HTA)

The purpose of HTA is to aid ___ by providing information about the impact of those decisions.

decision-making

The ___ organisations (EUnetHTA) has defined health technology assessment as: ‘a multidisciplinary process that summarises information about the medical, social, economic and ethical issues related to the use of a health technology in a systematic, transparent, unbiased, robust manner’. Its aim is to inform the formulation of ___ that are patient-focused and seek to achieve best value.

European Union Network of Health Technology Assessment

safe, effective health policies

Despite its policy goals, HTA must always be firmly rooted in ___ and the ___

research

scientific method

Generally speaking, HTA aims to inform decisions made in health systems about ___. This determination of value is complex and must take ___ into account.

which health technologies are of most value and should be invested in

policy and social context

means that all people have access to the health services they need, when and where they need them, without financial hardship. It includes the full range of essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care.

Universal health coverage

Currently, at least half of the people in the world do not receive the health services they need. About ___ people are pushed into extreme poverty each year because of ___ on health. This must change.

100 million

out-of-pocket spending

To make health for all a reality, we need: ___ who have access to high quality health services so that they take care of their own health and the health of their families; ___ providing quality, people-centred care; and ___ committed to investing in universal health coverage.

individuals and communities

skilled health workers

policy-makers

Universal health coverage should be based on ___. Good health systems are rooted in the ___ they serve. They focus not only on preventing and treating disease and illness, but also on helping to improve well-being and quality of life.

strong, people-centred primary health care.

communities

Factors that influence demand for health technology: 14

❖ “Cascade” effects of unnecessary tests, unexpected results, or patient or physician anxiety

❖ Advances in science and engineering

❖ Malpractice avoidance

❖ Aging populations

❖ Strong or growing economies

❖ Intellectual property, especially patent protection

❖ Third-party payment, especially fee-for-service payment

❖ Emerging pathogens and other disease threats

❖ Financial incentives of technology companies, clinicians, hospitals, and others

❖ Increasing prevalence of chronic diseases

❖ Clinician specialty training at academic medical centers

❖ Public demand driven by direct-to-consumer advertising, mass media reports, social media, and consumer awareness and advocacy

❖ Off-label use of drugs, biologics, and devices

❖ Provider competition to offer state-of-the-art technology

mandated the utilization of HTA in guiding PhilHealth’s coverage of health services (Congress of the Philippines, 2013).

RA 10606: National Health Insurance Act of 2013

required that any medicine considered for inclusion in the PNF shall be assessed its benefit-risk assessment (safety and efficacy), cost-effectiveness, affordability, and public health relevance. (Department of Health, 2016).

AO 2016 - 0034: The New Implementing Guidelines of the Philippine National Formulary System (PNFS)

provided an explicit framework for a systematic and consistent use of HTA to guide health coverage decisions of both the DOH and PhilHealth (Department of 31 Health, 2018).

AO 2018-0026: Framework for the Use of HTA to Guide Coverage Decisions in Support of UHC

institutionalized HTA as a fair and transparent priority- setting mechanism that shall be recommendatory to the DOH and PhilHealth for the development of policies, programs, regulations, and the determination of a range of entitlements such as drugs, medicines, pharmaceutical products, other devices, procedures, and services (Congress of the Philippines, 2019).

RA 11223: Universal Healthcare Act