Post on 05-Jun-2018
The experience of GREECE
MARY GEITONA, MSc, PhD
PRESIDENT GREECE ISPOR CHAPTER
ASSOCIATE PROFESSOR, UNIVERSITY OF PELOPONNESE
ISPOR 16th ANNUAL EUROPEAN CONGRESS 2‐6 NOVEMBER 2013
DUBLIN, IRELAND
Pricing and Reimbursement Process for Medical Devices in CEE
Outline
• Health Care Reforms in Greece
• Impact on Health Expenditure Evolution
• Overview and Impact on the Greek MD&D Market
• Pricing & Reimbursement of Medical Devices & Diagnostics
• Summary of Proposals for MD&D
Greek Memorandum
Keep public Healthcare expenditure at or below 6% of GDP
– while maintaining universal access
and
– improving the quality of care delivery
Recent reforms & measures
•Rapid implementation of healthcare system reforms over the past 3‐4 years based on Troika memorandum
•Centralized procurement implemented through the National Procurement Authority (EPY)
•All insurance funds have been merged into one Social Security Fund EOPYY
•Efforts to create an integrated IT system intra and across healthcare sector
•The implementation of the DRG system (KEN)
•Merging of hospitals to improve efficiency
•Internal & external controllers assigned to hospitals
•National Statistics Organization (ELSTAT) – provision of data in line with Eurostat, OECD in
line with the System of Health Accounts
Impact on Health Expenditure Evolution
Greece Healthcare Expenditure compared to Eurozone (2003‐2011)
8.6%
8.4%8.3% 8.4%
8.9%9.2%
10.0%
9.4%
9.0%
5.1%4.9% 4.8%
5.1%5.7%
6.0%7.0%
6.4%5.9%
8.5%
8.7%8.8%
8.7%
8.7% 9.0%
9.8%
9.7%
6.4%6.6% 6.6% 6.6%
6.6% 6.8%
7.5%7.4%
0%
2%
4%
6%
8%
10%
12%
2003 2004 2005 2006 2007 2008 2009 2010 2011
Τρέχουσα συνολική δαπάνη υγείας (% ΑΕΠ) ‐ Ελλάδα
Τρέχουσα δημόσια δαπάνη υγείας (% ΑΕΠ) ‐ Ελλάδα
Τρέχουσα συνολική δαπάνη υγείας (% ΑΕΠ) ‐Ευρωζώνη
Τρέχουσα δημόσια δαπάνη υγείας (% ΑΕΠ) ‐ Ευρωζώνη
Total Public HC Expenditure (%GDP) Greece
Total HC expenditure (%GDP) Eurozone
Total Public HC Expenditure (%GDP) Eurozone
Total HC expenditure (%GDP) Greece
Total Health Expenditure % of GDP
Public Health Expenditure % of GDP
-15%
-10%
-5%
0%
5%
10%
15%
Average annual growth in health spending across OECD countries in real terms, 2000‐2011
2000‐09 2009‐11
Note: Growth rates for Australia, Denmark, Japan, Mexico and Slovak Republic refer to 2009-10 instead of 2009-11Growth rates for 2009-11 are not available for Luxembourg, and Turkey.Growth rates for Chile calculated using the Consumer Price Index (CPI).
Health Spending across OECD
0
500
1000
1500
2000
2500
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
**2012
2013 est
MD&D Market Size 1995‐2012
Εξέλιξη Εγχώριας Αγοράς Ιατροτεχνολογικών Προϊόντων 1995‐2012MD&D Turnover Evolution 1995‐2012
‘10 vs ‘09 ‐ 23.5%
‘11 vs ’10 ‐ 27%
‘12 vs ’11 ‐16%
‘13 vs ’12 ‐10% πρόβλεψη
ICAP Κλαδική Μελέτη 2012
€2.337 εκ.
€0,950 εκ.
+12%
The Boston Consulting GroupSlow Burn – The need to transform the Medteck model in EuropeMedteck Europe
+12%
MedTech Performance ‐ Industry Index
% Change of value of the MD&D market
Q1 2011 Q1 2012 % Change
Consumables 102,665 77,129 ‐24,9%
Orthopedics 18,197 12,190 ‐33%
Reagents 37,326 35,201 ‐5,7%
158,189 124,520 21,3%
Year 1995 ‐ 2009 2010 vs 2009 2011 vs 2010 2012 vs 2011
% Change +12.3% ‐23.5% ‐27% ‐16%
Greece NHS Expenditure 3 main categories
Πηγή: Υπουργείο Υγείας ESY.netICAP Sectoral Study 2012
Pricing & Reimbursement of Medical Devices & Diagnostics
Private Hospital Reimbursement
Price is regulated according to the Price observatory
Payment comes out of the Hospital Budget
Payment comes from Private insurance
companies
DRG reimbursement covered by Social Security Funds
DRG calls for payment to be made by SSF according to DRG tariff
Patient out of pocket payment for amount not covered by insurance
Public Hospital Reimbursement
Price regulationSource of fundingType of
reimbursement
Payment comes from Public SSF
Reimbursement and Price Regulation
Tender contracts define agreed prices for a predefined period of time (Public tenders use price as
main evaluation criterion)
Out pocket for uninsured patients
Pricing & Reimbursement
Regional committees
National Evaluation Centre of Quality & Technology in
Health
National Social Security Fund
National Procurement Authority
Procurement through regional tenders
Inspection & testing of devices
Registration of Medical Devices& Technical Specifications
Directives on pricing & reimbursement
DRG reimbursement
ISO Certification & Medical Devices CE
National Tenders Price observatory
Hospital Administration
EPY
EOPYY
EKAPTY
DYPE
HospitalHospital tenders Price Observatory
Upload of PricesOut of Contract Procurement
MOH
Pricing/
Reimbursement
Price Observatory
Compliance
Tender Contracted
Prices
DRG Tariffs
Direct Hospital Orders
Price Regulating Factors
Price Observatory mandates price
Tenders use least cost selection criteria
Inhibits quality, technology adoption, innovation, advanced treatment
Evaluation based on Cost
Lack of Health Technology
Assessment (HTA) Committee
Lack of guidelines based on evidence for cost
effectiveness of procedures and medical technology
DRG tariffs need to reflect actual costs of procedures
Cost of medical devices doesn’t fit into certain DRG tariffs
Issues Impact
Medical Devices Issues and Impact 1/2
Lacks key criteria such as quality, volume, payment termsInflexible process for correcting descriptions & prices
Issues Impact
Fragmentation of IT systems
Misalignment of communication and control among the different healthcare organizations (Units/Hospitals/Providers etc)
Payment delays increase prices
High debts from hospitals to healthcare providers
Payment delays from Social Security Funds towards
hospitals
High debts from hospitals to healthcare providers
Payment delays from Social Security Funds towards
hospitals
NHS does not keep disease evidence data
Hospitals and health care providers do not have
guidelines for cost effectiveness of products & procedures
Medical Devices Issues and Impact 2/2
Advantages
• product classification ‐ descriptions • Price comparisons across hospitals• Higher price transparency and low price competition
Opportunities for improvement
Redefinition of the role of the Price Observatory
Revise Observatory processes :
•Reclassification of the coding system •Price setting based on quality, volume, payments terms criteria •Introduction of a price range per product and not mandating the lowest price •Correction of entries, and regular updating of prices
Price observatory mandates price
Lacks key criteria such as quality, volume, payments terms
Inflexible process for correcting descriptions & prices
Procurement: Price Observatory
Advantages
• Promotes competitiveness (high number of providers ‐ competitive pricing)• Simplified ordering process through contracts• Ensures transparency and legal compliance
Opportunity for Improvement
• Choice of the most economic advantageous tender (MEAT) with accuracy in:– Tender specification including percentage allocated to price & quality
– Simplification of the legislative process to avoid delays in assessing offers
– Minimization of beaurocracy related to providers’ documentation
– Improve tender evaluation timelines
Tenders use least cost selection criteria
Inhibits quality, technology adoption, innovation, advanced treatment
Procurement: Tendering
Opportunity for Improvement
• Reinforcement of the National Evaluation Centre of Quality & Technology in Health (EKAPTY) to assess health technology and provide guidelines promoting superior patient outcomes and cost – effectiveness
• OR establishment of a new organization
• Include multiple stakeholders input, transparency, flexibility and systematic evaluation and improvement
Lack of Health Technology Assessment (HTA) criteria
To provide guidelines based on evidence for cost effectiveness of procedures/technology
Inhibits quality, technology adoption, innovation, advanced treatment
Health Technology Assessment
DRG tariffs need to reflect actual costs of procedures
DRG’s
Cost of technology doesn’t fit into certain DRG tariffs
Advantages
• Introduction of DRGs (in 2011) based on ICD ‐10 coding• Reflection of total hospitalization cost• DRG culture has started to be engrained in healthcare
Opportunity for Improvement
• A micro costing analysis is needed to reflect actual cost of DRGs
• MD&D accuracy of calculation in DRGs
• Personnel salaries need to be included in the DRGs tariffs
• Promote day surgery options by introducing outpatient tariffs
Summary of Proposals
Proposals for MD&D
• Develop an economically stable and predictable environment for the industry
• Economic sustainability of EOPYY the national social security fund
• Improve the existing infrastructure for funding and payments across the healthcare system
• Implementation and ongoing improvement of proposed reforms vs introducing new reforms
• Multiple stakeholder engagement in decision making
• Alignment of electronic systems for better communication & control across the system
• Consideration of HTA criteria by Pricing & Reimbursement decision makers
• Redefinition of the role of the Price Observatory and overall process improvement
• Improvement of DRG’s – reflect actual costs of devices
– include regular updates for description and tariff accuracy
– reimbursement of accepted, innovative cost ‐ effective devices
Thank you