Main topics of the conference were ways for improving state guarantees program and compulsory health insurance systems, world practice of developing national healthcare programs, approaches to financing of innovations in Europe, enhancement of outpatient care in the frames of national healthcare programs, quality control and Value-Based Healthcare (VBH, BP, P4P), adoption of innovations into healthcare system.
The conference was opened by Tatiana Kusaiko, Senator of the Federation Council of the Federal Assembly of the Russian Federation, Deputy Chair of the Federation Council Committee on Social Policy, who emphasized relevance of the topic chosen for the conference. “Nowadays healthcare is one of the most innovative fields in social sector. By admitting the fact that innovative technologies have a huge impact on medical care quality, all countries are facing the challenge of finding a proper balance between relevance of innovations and their affordability, including ways of their financing. We need a system that would ensure objective and adequate adoption of innovations into the healthcare system. Thus, the system of health technology assessment (HTA) should facilitate their adoption, as well as budget optimization. Using HTA principles for studying innovative technologies helps to carry out a comparative analysis of clinical effectiveness and efficiency of new technologies in comparison to existing technologies and medicinal products that are being reimbursed,” the Senator concluded.
Igor Kagramanyan, First Deputy Minister of Health of the Russian Federation, also noted that without HTA instruments it is impossible to build effective, safe and cost-effective medical care system. HTA allows to evaluate data on medical interventions and allocate health system resources within budget constraints. HTA is used not only for medicinal products, medical devices but also for decision-making in actualization and development of clinical guidelines, development of medical care standards, priority setting in primary health care and introduction of public health programs.
Deputy Chair of the Federal Compulsory Health Insurance Fund, Yuriy Necheporenko, said that relevance of advanced technologies, first of all, relates to effective DRD-based payment methods which help to decrease inefficient costs of medical organizations. Referring to the latter, Deputy Chair noted that in vitro fertilization, which is a complex series of procedures, is possible to pay using DRG system. He also mentioned about inclination to personalize medical care payment for patients with malignant tumors depending on treatment, drugs and dosing regimens used for a particular patient. “Since 2018, drug therapy schemes have been used to determine cost of drug therapy for adult patients with malignant tumors in Russia. This method has proved to be an effective tool for determining total cost of a treatment of a particular patient”. According to Y. Necheporenko, in 2019 Federal Compulsory Health Insurance Fund in collaboration with the Center for Healthcare Quality Assessment and Control performed recalculation of all drug therapy schemes and DRGs taking into consideration approved clinical guidelines and drugs cost. In 2021 the list of drug therapy schemes is planned to be expanded. This would make payment for medical care, covered by compulsory health insurance fund, more personalized, consequently more flexible, and fully covering costs of medical organizations for providing timely and high-quality medical care.
Melita Vujnovic, WHO Representative to the Russian Federation, and Yuriy Kobzev, Deputy of the State Duma, Member of the State Duma Committee on Health Protection also contributed to the opening ceremony.
Vitaly Omelyanovskiy, General Director of the Center for Healthcare Quality Assessment and Control of the Ministry of Health of the Russian Federation, gave a talk on ways of improving State Guarantees Program and Compulsory Health Insurance systems. “Currently, there is a number of challenges for implementation of the Program of State Guarantees of free medical care in Russia. First of all, these are lack of financing mechanisms based on clinical guidelines and medical care procedures, allocation of CHI budget between constituent entities of the Russian Federation without taking into account regional aspects, discrepancy in CHI rates and actual cost of medical organizations, lack of clear science-based criteria for decision-making on including innovative treatment methods into the State Guarantees Program and exclusion of ineffective treatment methods,” the speaker stated. In order to improve the State Guarantees Program it is necessary to set up balancing mechanisms based on medical care standards, take into account regional aspects, calculate CHI rates based on cost-accounting system of medical organizations, adopt new payment methods for outpatient care, include drug provision for outpatient care into the basic CHI program, enhance medical care system, extend waiting time for planned medical care, set up an effective mechanism to overhaul high-tech medical care methods using approaches to evidence-based medicine and clinical and economic analysis, and also change principles of involvement of medical organizations in CHI system.
Inna Zheleznyakova, Deputy General Director of the Center for Healthcare Quality Assessment and Control, shared her insight on adoption of innovative drugs into the healthcare system. It was noted that there are two possible options to regulate this process. First of all, current legislative framework for clinical approbation and high-tech medical care should be improved, and secondary, new principles of legislative regulation process should be established.
Moreover, one of the talks was devoted to the 20 years history of the State Guarantees Program, delivered by Vitaly Flek, Deputy Minister of Health of the Russian Federation. Yuriy Kobzev, Deputy of the State Duma, Member of the State Duma Committee on Health Protection, talked about improving the effectiveness of outpatient care within national health programs. Nuriya Musina, Head of Development and Communications Department of the Center for Healthcare Quality Assessment and Control, focused on cell and gene therapies, emphasizing future key role of advanced therapy in healthcare system, the need for legislative framework improvement and new financing mechanisms taking into account special features of such medicinal products (limited clinical data, high cost, lack of data on long-term effects). Head of the Department for HTA Methodological Support of the Center for Healthcare Quality Assessment and Control, Georgiy Khachtryan, declared the need to introduce the term “innovative medical technology” at legislative level in Russia, suggesting criteria to assess such technologies (their additional therapeutic value) and ways how to interpret and implement assessment results into the comprehensive assessment system in Russia. Andrey Yanovsky, Chairman of the Board, National Association of Non-Governmental Medical Organizations, shared his knowledge in involvement of private medical organizations in the State Guarantees and Compulsory Health Insurance programs.
Joseph Kutzin, Head of the Department of Health Systems Governance and Financing, WHO/Geneva, delivered a talk on lessons from international experience on health financing for universal health coverage. Tihomir Strizrep, Consultant in Health Care Financing, Tihomir Strizrep Consulting Services, provided insights into HTA and hospital payment system based on Diagnosis Related Groups.
In the frame of the conference, a panel discussion took place “Government and industry. How to achieve a consensus”. Main topics for discussion included: financing of innovations within budget constraints (views of industry and government); need for negotiation process in assessing innovations and developing clear criteria for economic sustainability; interaction at the stage of production; identification of priority products from the perspective of evidence-based medicine and innovation value; development and research of innovative medical technologies considering government requirements (clear request from the government); early assessment of innovative technologies to predict acceptability for society and timely production cancellation; need for the industry to move from products promotion (medicines, medical devices) to decision promotion (patients routing, etc.); process reduction: from design to introduction.
Organizers of the conference comprised of Federation Council Committee on Social Policy, Ministry of Health of the Russian Federation, Center for Healthcare Quality Assessment and Control of the Ministry of Health of the Russian Federation, Russian Patients Association, Global Network for Health Financing and Social Health Protection (P4H), Russia HTA Chapter of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) and others.