Spreker | Plaats | datum

Getting the relevant answers…

KNAW - Science for affordable Health Careapril 17th, 2013

Bert BoerHealth Care Insurance Board

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Is there really a need for research?

Wilco Peul: MRI after spine surgery…

Gert Westert: Gall bladder surgery…

There is a massive lack of knowledge in usual health care (not for new interventions only)

Most of Health Policy decisions don’t lean on evidence

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Getting the relevant answers…

Factors responsible for trends in HC cost

So what do we need to know?

What is needed to get the appropriate answers?

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Health Care Cost (data derived from CPB)

14% of GDP Top of the western world after USA Per capita: 5,400 € Two-child family: > 20,000 € 25% of all Collective Finance (2009)

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Factors for trends in HC expenditures

Demand:EpidemiologyBehaviour

Supply:TechnologyBehaviour

Health Care System, influencing cost patterns(Heijink, 2009)

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Decomposition of trends in HC expendituresCPB 2012: (Decompositie van de zorguitgaven, 1972-2010)

Price trends in HC(more suppliers, higher wages, new

technology)

Demographic factors (only for) 1%

Major cost trend since 2000 is due to governmental policy (AB: we stimulate production all the way..)

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Understanding health care cost trends:

The way elements of health care systems influence HC utilisation and cost

Health Service ResearchPeter Groenewegen (2004): the (lacking) evidence for “Vraag

aan bod”

The value and cost of HC technologyfor specific patient categories

Health Technology AssessmentThe relative effectiveness of proton therapy for different

types of cancer

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So what is the actual need to know

Relative value (effects, QoL, cost) of new and existing technologies for different patient categories; incl. predictors/modifiers of effect= HTA

How can we enhance the proper use of health technology (“gepast gebruik”): Information, Payment methods, Organisation, Education..?

= HQR, HSR

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What hampers the availability of necessary knowledge ?

(Advisory Council on Health Research: Healthy services research. The future of health services research in The Netherlands. 2008; RGO no. 59.)

1. The “academic status” of HSR, HTA (Priorities of Scientific Journals, of Research Funders, of

Medical Faculties)

RGO: Reinforce the (HS..) research infrastructure in such a way that practical and policy issues can be rapidly addressed, while allowing sufficient scope for innovation on the part of the research community

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What hampers…

2. Science and Policy two separate worldsa structural lack of communication, trust, and

interaction

RGO: Ensure systematic and mandatory interaction between researchers and knowledge-users in order to improve the exploitation of knowledge (AB: in all phases of a research project)Make evaluation a formal component of every transition in policy and health care practice; instruct researchers and knowledge-users about each other’s working practices

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What hampers…

3. Articulation of the relevant questions by policy makers…

(Health Services researchers, Health Policy researchers:

shift from the critical mode to the contributive, ‘selling’ mode)

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What hampers…

4. Publication bias

There is evidence for publication bias, decreasing the chance of publishing negative outcomes and for evaluation of existing/old technology

So we overestimate the contribution of new (mostly more expensive) technology and we ignore the lack of evidence of common health care

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What hampers…

5. Clinical practice and research are insufficiently integrated

Relevant questions from common clinical practice don’t get the chance…

We urgently need practice-based-evidence development

Registration of outcome data on behalf of evaluation should be integral part of clinical practice (and of payment)

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Recommendations

1. Give HSR, HPR, more status (money, attention)

2. Give room for evaluation of day to day health care technology

3. “Sublimate” (justified) criticism towards policy makers into contribution to perceived problems; interact, communicate, ask questions

4. Integrate evaluation research in clinical practice (tools: clinical registries; attitude: ‘research mode’ as part of professionality)

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Finally

5. Integrate evaluation systematically in the Professional Quality Circle (Ben Willem Mol: research projects resulting in evidence, leading to guidelines, implementation, utilization data, feedback on practice and re-evaluation if needed)

Doing so, we “flip” the classical model, in which policy, research and practice are distinct areas, to a comprehensive, problem-centered approach in which practice, policy and research have a common focus on specific problems in health care

Spreker | Plaats | datum

Getting the relevant answers…

KNAW - Science for affordable Health Careapril 17th, 2013

Bert BoerHealth Care Insurance Board