HTA in Austria Ekonomika zdravotnictví, standardy kvality zdravotní péče a HTA, Praha

1. HTA in Austria Ekonomika zdravotnictví, standardy kvality zdravotní péče a HTA, Praha May 6, 2010

4. 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.

5. 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.

6. Contracts on implementationcompetenceshift Federation of Social security Funds Federal administration Ministry of Health regional administrations Out- Social Insurance Funds Federal healthcommission Regional „HealthPlatforms“ In- Service negotiations Service negotiations patients doctors/-chambers other health professionals hospitals/hospital carriers

7. 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).

8. 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)

9. 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

10. Ministry of Health Stakeholder Stakeholder Fed agency of health  development, implementation and factual control HTA work group Fed. state / provinces / sozial insurance UAG Qualität National HTA Strategy Gesundheit Österreich Federal institute for quality in health care system HTA expert pool from Austrian and German HTA organisations  clearing house, information platform  specialist advice and co-operation

11. 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

12. e.g. for AHRQ Department for evidence based medicine Donau UNI Krems GÖG/BIQG e.g. forIQWiG EBM Review Center – Med UNI Graz e.g. for DIMDI

13. First Austrian HTA-Symposium on May 3rd 2010

14. 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

15. 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

16. 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.

17. Because what you told me is absolutely correct but completely useless Where am I? The problem Yes, how did you know? You must be a researcher Because you don’t know where you are, you don’t know where you’re going, and now you’re blaming me You’re 30 metres above the ground in a balloon You must be a policy maker Yes. How did you know?

18. Contact MMag. Elisabeth Breyer Stubenring 61010 Wien, ÖsterreichT: 1234567-112F: 12345678E: elisabeth.breyer@goeg.atwww.goeg.at