Lecture 8 - Defining Benefits and Beneficiaries

Question 1

What is a Health Technology Assessment (HTA)?

Answer 1

A systematic and multidisciplinary process that evaluates the properties, effects, and impacts of a health technology.

Question 2

What is covered by a regulatory agency vs a HTA?

Answer 2

Regulatory agency: safety and efficacy

HTA: efficacy, effectiveness, efficiency, affordability

Question 3

What are HTA’s used for?

Answer 3

To inform policy decisions

Is the intervention worth it? e.g. service results in cost savings but has low effectiveness = not adopted

Question 4

How can you reduce the demand of health services?

Answer 4

1. Divestment via financial mechanisms:
   - Cost sharing
   - Reference pricing (generic vs branded medicine)
2. Divestment via non-financial mechanisms:
   - Education: Educational campaigns can raise awareness about the importance of preventive care, such as healthy lifestyle habits, vaccinations, and regular screenings. Educational programs can equip patients with the knowledge and skills to manage chronic conditions effectively, potentially reducing the need for frequent doctor visits or hospitalizations.
   - Shared decision-making: Shared decision-making can help patients understand when certain procedures might offer little benefit or have significant downsides, leading them to potentially opt for watchful waiting or less aggressive approaches. When patients feel involved in their healthcare decisions, they are more likely to be engaged in managing their health and adhering to treatment plans, potentially reducing the need for further interventions.
   - Public reporting (report on low-value care): Public reporting on low-value care practices shines a light on treatments that offer minimal benefit at a high cost. This information empowers patients to ask questions and potentially avoid unnecessary procedures.

Question 5

How can you reduce the supply of health services?

Answer 5

1. Divestment via financial mechanisms:
   - Pay for performance: P4P rewards providers for meeting specific performance measures related to quality and efficiency.
   - Comparative effectiveness research to make payers unlist certain services
   - Risk sharing: Risk-sharing arrangements, like capitation, can financially penalize providers for exceeding a set budget for patient care. This might discourage them from offering certain services, especially preventive care or complex procedures, if they perceive the potential costs to outweigh the rewards.
2. Divestment via non-financial mechanisms:
   - Clinical support tools: These tools can encourage standardized protocols and more efficient practices, potentially leading to fewer unnecessary tests or procedures being performed. This reduces overall resource utilization, which can be perceived as a decrease in supply.
   - Education (clinical guidelines): Clinical guidelines promote the use of evidence-based practices, which may involve fewer interventions compared to traditional approaches
   - Feedback to providers: Feedback based on data analysis can highlight instances where providers might be ordering unnecessary tests or procedures.
   - Audit: Audits can reveal inefficiencies or wasteful practices within the healthcare system.

Question 6

What is pay for performance?

Answer 6

Pay for performance (P4P), also known as value-based purchasing, is a healthcare financing system that links financial rewards for providers and healthcare organizations to their achievement of specific performance measures.

Question 7

What are the advantages and disadvantages of reducing supply-side care?

Answer 7

Advantages:
- Can directly control healthcare spending by reducing unnecessary services and procedures.
- Can incentivize providers to focus on preventive care and efficient resource utilization.

Disadvantages:
- Risks limiting access to necessary care, particularly for complex or high-cost conditions.
- Might discourage innovation in healthcare if new, potentially beneficial services are restricted.
- Can negatively impact provider morale and job satisfaction.

Question 8

What are the advantages and disadvantages of reducing demand-side care?

Answer 8

Advantages:
- Empowers patients to make informed choices about their healthcare, potentially reducing unnecessary utilization.
- Can promote preventive care and healthier lifestyles, leading to fewer health problems in the long run.
- Can potentially improve patient satisfaction and engagement in their health.

Disadvantages:
- Relies on effective education and behavior change, which can be challenging to achieve.
- Might not directly address the high costs of certain essential medical interventions.
- May not be as effective in the short term as directly reducing supply.