Dilemmas Over the Approval and Delivery of New Health Technologies in a Fragmented and Inefficient System

In today’s post, Eugenia de la Fuente of GLOBALHealthPR Argentina partner Paradigma PEL Comunicación explains why Argentina needs a uniform health technology assessment process – and why the media should take notice of the issue.

There is no doubt that advances in health technology have provided tremendous benefits to patients. In Argentina, patients have pursued access to innovative treatments through court actions, which have been increasing in frequency along with each new drug approval and diagnosis method.

This creates a lack of uniformity in how treatments are covered and delivered, and demonstrates that health systems throughout the world should use caution when deciding which technologies to cover and, perhaps more importantly, how to bear the expenses which will inevitably follow a given decision.

To put what is happening in Argentina into context, Dr. Gabriel Novick, former Undersecretary of Health Planning of the City of Buenos Aires, recently gave a talk to a group of healthcare journalists. “One must consider which technology the country needs, who it is for, and how it should be approved, because the scope of the issues that make the newspapers’ front pages is limited.  When healthcare is discussed, the media agenda covers only an infinitesimal part of the story in Argentina, and usually only takes an interest in socio-health problems,” said Dr. Novick after showing a scribbled image designed to illustrate the Argentine health system. “Within this framework, coverage of the technology assessment process is negligible,” he said.

However, Novick, now the Corporate Medical Director of Swiss Medical Group (which offers private healthcare to about a million members) elaborated further. He went on by saying that in spite of the aforesaid, there are three elements that add significance to the topic: “New technologies appear throughout the country on a continuous basis. These technologies are poorly assessed. All this occurs in an inefficient socio-health system that,” he pointed out, “generates a complex cocktail that has a vast systemic impact. This is why this issue is so important.”

Under the title “Assessment and impact of new technologies in the current health care context in Argentina,” the expert made a short review of the local healthcare situation, quoting, to begin his speech, a phrase from the Report on Oncology in Latin America published in 2013 in The Lancet Oncology: “The lack of integration of the health system of Argentina results in poor access for people.”

Social “security” and coverage confusion

In Argentina, social security does not have the same meaning as in other countries. For example, in Mexico there is the Social Security Institute, a single system to which everybody contributes part of their income. The healthcare system is not fragmented into a large number of health plans, some of which are more solvent than others. In Argentina, health plans are just a segment of social security. This is the reason why the dispersion is so significant, explained Novick. He went on to present data that reflect this fragmentation, which has turned Argentina into a study case worldwide:

• 62% of the population is covered by a union-run health plan (national or provincial);
• 15% has a private health plan (some members divert their contributions from their union-run health plan to the payment of the private plans and some are direct members); and
• 36% receives health care through the public system (public hospitals).

“As you see, the numbers don’t add up. Based on these figures, healthcare services are provided to 60 million people, while the country has 40 million inhabitants. How come?” Novick wondered. He then mentioned that, for example, the number of people with dual coverage amounts to 1,650,000. “This is inefficient,” he concluded.

In addition, Novick pointed out the existence of regional and social dissymmetry in access conditions and presented the differences between the low-income and high-income population in relation to important indicators such as “health service deficit” (12 to 1); “overcrowding” (10 to 1); “gas supply” (13 to 1); “waste collection deficit” (9 to 1). “All this has an impact on health and raises the question of which, then, is the technology that the country needs and whom it needs said technology for. And the how, included in the initial question, becomes even more important,” he remarked.

Moving toward a common standard

Next, he showed the image of a colander standing next to a brain. ‘The model we should follow is that of a single intelligent sieve. This model is used in many parts of the world and has started to be implemented in several countries in Latin America. For example, Colombia has just gone back to square one and established a single technical agency. This is what we should be targeting: a single technical agency that weighs intelligently all the variables that have an impact on the absorption of new technologies: cost, quality of life, potential damage, clinical results, financial sustainability, sustainability over time’, enumerated Novick.

He explained that U.K. standards are the best example of the assessment of new technologies. “Virtually all the rest of the world is still far away from the English agency of technology assessment, but Colombia is doing this; Ecuador is doing this. All Latin America is moving towards a single, intelligent filter. We are more similar to this,” he said, pointing to a picture showing several basketball nets, one next to the other. “We have multiple places where things merely happen, although only two are binding: The National Drug, Food and Health Technology Administration (ANMAT), which is responsible for approvals, even when the assessment conducted by it is totally arbitrary, and the Assessment Agency of the Undersecretariat for Health Care Services, which has authority to require coverage. Now, are they willing or empowered to provide the guidelines and enforce the mandatory rules needed? The answer is, ‘no’,” concluded Novick.

Finally, the expert summarized: “A critical assessment process is needed to determine which molecules enter the health system, under which conditions, what their budgetary impact is, and how we are going to finance all this. The arbitrary entry of new technology in such a complicated environment is unacceptable. Everything for everybody is not an option; in fact, there is a lot for a few, and little for many. When one speaks of new technologies, one has to weigh these variables in order to be truly effective.”

Does your country have a uniform health technology assessment process?