SN1: Health service reimbursement

ACPE UPN: 0475-0000-14-005-L04-P. A knowledge based activity.

Abstract

Nearly all health systems in the world report a problem with financing of health services including drug therapy. Focussing on drug therapy this is easy to understand. New drug therapies are often very expensive, bringing sometimes only a small benefit in terms of patient outcomes. In some health systems diseases like cancer, autoimmune diseases or rare diseases therapies are discussed as not affordable for all patients anymore. Some health systems included measurements like QALY in their decision-making processes. Other countries decide drug reimbursement on a named patient basis or as individual case-by-case decisions. In cancer therapy there is a controversial discussion about the "value" or "benefit" of therapies and trying to answer the questions using disease-free-survival, progression-free-survival, 5-year-survival etc. as outcome parameters of cancer treatments. The differences of survival in clinical studies versus survival in real-life patient populations are also under discussion. Specifying these thresholds as reimbursement criteria seems to be problematic as patients with rare diseases don‘t have the choice between different kinds of therapies with different dimensions of expenses. Speakers at this seminar will give an overview over the decision process in reimbursement of health services by focusing on drug therapy.

Teaching Goals: 

• to name any different approaches of Switzerland and Germany,
• to report the processes which lead to the decision for reimbursement of new and expensive drugs,
• to describe examples of the outcome of the decision process. 

Learning Objectives: 

After the presentation the participant should be able:

• to name the different process steps leading to the decision for reimbursement,
• to recognise the possible different approaches to come to a decision for reimbursement.