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Getting the relevant answers… KNAW - Science for affordable Health Care april 17th, 2013

Getting the relevant answers… KNAW - Science for affordable Health Care april 17th, 2013. Bert Boer Health Care Insurance Board. Is there really a need for research?. Wilco Peul: MRI after spine surgery… Gert Westert: Gall bladder surgery…

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Getting the relevant answers… KNAW - Science for affordable Health Care april 17th, 2013

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  1. Getting the relevant answers…KNAW - Science for affordable Health Careapril 17th, 2013 Bert Boer Health Care Insurance Board

  2. 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

  3. 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?

  4. 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)

  5. Factors for trends in HC expenditures • Demand: • Epidemiology • Behaviour • Supply: • Technology • Behaviour • Health Care System, influencing cost patterns • (Heijink, 2009)

  6. Decomposition of trends in HC expenditures • CPB 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..)

  7. Understanding health care cost trends: • The way elements of health care systems influence HC utilisation and cost • Health Service Research • Peter Groenewegen (2004): the (lacking) evidence for “Vraag aan bod” • The value and cost of HC technology • for specific patient categories • Health Technology Assessment • The relative effectiveness of proton therapy for different types of cancer

  8. 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

  9. 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.) • 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

  10. What hampers… • 2. Science and Policy two separate worlds • a 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

  11. 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)

  12. 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

  13. 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)

  14. Recommendations • Give HSR, HPR, more status (money, attention) • Give room for evaluation of day to day health care technology • “Sublimate” (justified) criticism towards policy makers into contribution to perceived problems; interact, communicate, ask questions • Integrate evaluation research in clinical practice (tools: clinical registries; attitude: ‘research mode’ as part of professionality)

  15. 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

  16. Getting the relevant answers…KNAW - Science for affordable Health Careapril 17th, 2013 Bert Boer Health Care Insurance Board

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