Presentacion cracovia

Hinweis der Redaktion

1. The Superintendence of Social Security depends on the Ministry of Health. Is the regulatory board of Social Health Insurance in Argentina that provides coverage to Fifteen (15) million people. In 1996 was responsible to set the first mandatory benefit package, the PMO. This extensive package of services covers most of the medical technologies including expensive practices such as magnetic resonance imaging or organ transplantation. In the year 2000 the Institute was called to analyze critically the services included in the PMO. After the analysis, it was concluded that a high percentage of the services should be revised through a formal process of HTA. We considered that the coverage of many services should be restricted to specific clinical conditions and that it was necessary to define a formal and explicit process to adopt and incorporate a new technology.
2. In a sub analysis of the 500 services most recently incorporated at that time, we found that there was good evidence to support the inclusion of 4% of them. There was good evidence for 22% but it was concluded that to avoid misutilization it would be necessary to clearly specify the clinical conditions for which the services were indicated. There was good evidence about effectiveness for 65%, but the inclusion into the package was questionable due to cost- effectiveness and the need to provide the service in our context. Finally, there was good evidence to exclude nearly 10% of the services. We also found that 12% of the technologies analyzed were responsible of 80% of the cost. We recommended at that time that this should be considered in the selection of services to include in a formal HTA process.
3. For this report we revised all the technical documents and activities of the HTA commission between year 02 and 04 inside the Superintendence.
4. Between 02 and 04 a total fo oof 193 technologies were evaluated. 36% of them were drugs, 30% were therapeutic technologies and 34% were diagnostic technologies.
5. Out of the 193 services evaluated, 104 were technologies already covered that were evaluated to revise its status in the PMO. 46% were technologies considered for incorporation and technical notes about specific situations.
6. Finally, HTA reports allow decision makers to modify and adjust coverage status of more than 100 services included in the mandatory package of services. As a result of the program, 10% of the technologies were excluded because of lack of effectiveness and in 67% the coverage was limited to specific clinical conditions.
7. In mid-03, the Superintendence, issued a guideline for submission of new technologies which required local data to evaluate C/E and potential budgetary impact. Since then, 89 candidate technologies were submitted for review.
8. Conclusions. Social Security Policy makers became more aware of HTA reports and its relevance on decision making as a result of this program. The HTA reports elaborated, allow decision makers to modify and adjust coverage status of more than 100 services. And the new guideline for submission of technologies to the Superintendence formalized an explicit process to incorporate new technologies.
9. It is concluded that HTA has had a limited albeit important impact to evaluate efficiency of the services covered by Social Health Insurance in Argentina. Further steps should strengthen the formal link between HTA and decision making and foster the adaptation of HTA to our own reality.