CENETEC: Three years experience of a health technology assessment unit in Mexico Rosa María Ceballos March, 2008

1. CENETEC: Three years experience of a health technology assessment unit in Mexico Rosa María Ceballos March, 2008

2. Contents • Introduction • Challenges • Strategies • To improve HTA production • To increase the use of HTA • To foment collaboration • To disseminate results • Conclusions

3. Contents • Introduction • Challenges • Strategies • To improve HTA production • To increase the use of HTA • To foment collaboration • To disseminate results • Conclusions

4. 103 million inhabitants 2 million KM2 74% Urban population 24 million people in towns less than 2,500 ih

5. PRIVATE AND OTHERS 6% POPULAR INSURANCE 14% 6% 49% 25% Segmentedhealthservices Ministry of Health and 32 states C

6. Mexican Health Care System: Structure, financing and coverage Fed/State Govern. Gral. Taxes Fed. Govern. General Taxes Employers Payroll Contributions Employees Payroll Contributions Employers Direct Payment Family fees Individuals Out-of-Pocket Financing Ministry of Health / National Commission of Financial Protection in Health ISSSTE Army / Navy PEMEX IMSS Private Insurance Operation Ministry of Health of each state Private Hospitals, Clinics and Physicians Fee for Service Hospitals & Clinics owned by the Social Security Salaried Physicians Delivery Public Hospitals & Clinics owned by the Ministries of Health Salaried Physicians Any citizen High & Medium Income Poor Unemployed Self-employed Workers families Retirees Salaried Workers Beneficiaries Structure Social Security Popular Insurance Private Sector 6 Ruelas E. HTA and Governance in the Americas. Lecture in the HTAi Meeting, Montrel 2008

7. Health Technology Purchasing Decision Making Process General Health Council Basic Chart Private Sector Decision free of restrictions (2% analyze, evaluate) COFEPRIS* Ministry of Health Other Gov. IMSS Federal level CENETEC** Registry Drug & Equipment list Technology Assessment Unit National Health Council Estate level Health Technology Purchasing 7 Ruelas E. HTA and Governance in the Americas. Lecture in the HTAi Meeting, Montrel 2008

8. CENETEC MEDICAL EQUIPMENT PLANNING HEALTH TECHNOLOGY ASSESSMENT eHEALTH AND TELEMEDICINE Telemedicine guidelines Teleconsultation guidelines Operation E health web site Certificate of need HTA reports Clinical Practice Guidelines Patient information Technology guidelines Models for hospital equipment Clinical Engineering Master Medical Equipment Plan

9. Challenges • Increase HTA production • Scientific credibilityof producers • Standardize assessment methods • Increase the use of HTA among decision makers • In priority setting • HT incorporation

10. Barriers • Ned for multidisciplinary team • Pressure from caregivers • Pressure from vendors and consumers • Inertia • Explicit priority setting is difficult to “sell”, similar to “rationing” • Corruption

11. Facilitators • Decision makers trust CENETEC´s products for medical equipment planning. • Legal support documents: • National Health Program 2007-2012 • Main objective: to increase safety, accesibility, quality and safety in HC. • 4.3 To set priorities among interventions based on a process of assessment of clinical, economical, social and ethical • 4.5 To promote HTA • Political support!

12. The poorest the country, the more the efforts towards HTA. Enrique Ruelas B. Secretario del Consejo de Saludbridad General HTA and Governance in the Americas. Lecture in the HTAi Meeting, Montrel 2008

13. Contents • Introduction • Challenges • Strategies • To improve HTA production • To increase the use of HTA • To foment collaboration • To disseminate results • Conclusions

14. Increase the use of HTA • Becoming advisors for the General Health Council in HT incorporation to the Basic Chart • Providing information for the Drug Price Negociating commision • Legal support • Modification of CENETEC’s legal attributions • National Health Program 2007-2012 • WHA 60

15. WHA60.29 Resolution Approved on may 23rd, 2007. Urges the member states: Collect Information of medical devices, prioritization needs, resources allocation. National strategies for assessment, planning, procurement and managment of HT National guidelines for GMP, quality,safety and efficacy, and International harmonization Establish national institutes for HT http://www.who.int/gb/e/e_wha60.html

16. Cenetec´s products ... Certificate of need High cost Medical Equipment Needs assessment: Clinical need Similar equipment in the area, productivity and availability Specialized personnel available Acquisition alternatives Cost-benefit analysis

17. ... Cenetec´s products • HTA • Clinical, economical, social and ethical implications • Full report • Evidence informed recommendations • One or two dimensions • 5 year search • Published studies only • Simplified report

18. CENETEC’s products

19. Improving HTA production • Generate consensus over methodology • Economic evaluation methods document from General Health Council • Networking • Identification of key producers • First HTA network meeting • Training • Introductory course to HTA • Specific courses planned

20. Results dissemination • Gaceta CENETEC • HTA section in CENETEC’s webpage • Proposed website for HTA network • Anual HTA workshop

21. Contents • Introduction • Challenges • Strategies • To improve HTA production • To increase the use of HTA • To foment collaboration • To disseminate results • Conclusions

22. HTA in México: Working on production and use Consider all Healtcare providers Credibility of producers Provide legal foundations to work Reform when necessary Networking Standardization Training Beleiving that what we do will help provide better health care for all mexicans! striving….not giving up!

23. ¡Gracias! rceballos@salud.gob.mx Centro Nacional de Excelencia Tecnológica en Salud +5255 5208 3939 www.cenetec.gob.mx