Health Care for all Creating Effective and Dynamic Structures How does the Institute for quality and efficiency in health care work? Peter T. Sawicki; Institute for Quality and Efficiency in Health Care.
Why does the German health care system need IQWIG? A general community based solidarity system providing health care for all needs protection.
Rep. Debbie Riddle (R-Houston): "Where did this idea come from that everybody deserves free medical care? It comes from Moscow. From Russia. It comes straight out of the pit of hell." Molly Ivins: Washington Post 15 th May 2003
Otto von Bismarck The Iron Chancellor
On June 15 th 1883 The Health Insurance Law including a mandatory health insurance passes the German Reichstag.
2008: Social Code Book V The insured are entitled to care when it is necessary to detect an illness, to heal, to protect against worsening of the condition or to relieve symptoms.
Problems of general access to all medical interventions 1) Increase in the use of unnecessary interventions: Possible increase in harm. 2) Increase in the use of very expensive interventions: Possible increase in costs.
IQWiG s task Implementation of scientific methods for an effective protection of patients from unnecessary harm and society from unnecessary costs.
Prerequisite for Creating Effective and Dynamic Structure in Health Care Scientific definition of necessary diagnostic and therapeutic interventions.
Kosten und Nutzen in der Medizin How does the IQWiG Work Ministry of Health Legal oversight Federal Joint Committee - GBA Patients, Physicians, Sickness Insurance Funds and Hospitals Decision making http://www.g-ba.de Institute for Quality and Efficiency in Health Care Evidence assessment and http://www.iqwig.de information
Kosten und Nutzen in der Medizin Process of IQWiG-Reports 1) Request for a report by the National Joint Committee or the Ministry of Health 2) Appointment of external experts 3) Definition of outcomes and methods 4) Report plan - hearing 5) Preliminary report 6) Internal and external review 7) Preliminary report - hearing 8) Final report including recommendations
Patient-oriented trial outcomes (benefit and harm): Life expectancy (mortality) Complaints and complications (morbidity) Health-related quality of life Intervention-related burden Patient satisfaction
Method of benefit assessment A fair comparison between alternatives.
1. There is proof of benefit. Positive evidence 2. There is proof of the lack of benefit. Evidence of absence 3. There is no proof of benefit. Insufficient Evidence
1. There is proof of benefit. Reimbursement 2. There is proof of the lack of benefit. No reimbursement 3. There is no proof of benefit. No reimbursement, but investigation
Future Concept for a four step evaluation of benefit in new medical interventions 1) Does it address an important problem? 2) Can it work? 3) Does it work? 4) Is it costeffective? Description of deficits in a health care context. Experimental trial. Real life evaluation. Analysis of the relation between benefit and costs.