A Decade to the Updating Process of the

A Decade to the Updating Process of the National List of Health Services in Israel Orna 1 The 1, 2, Tal Nina 1, Hakak Joshua 1 Shemer Israeli Center for Technology Assessment in Health Care 2 Division of Medical Technology Policy, Ministry of Health, Israel The Process – Stages in Priority-Setting Background Stage There is a perpetual imbalance in health care systems; demands are infinite and resources limited. Exponential development of emerging technologies and the policy of provision through public funding, raise the need for wise decisionmaking. Values also play a paramount role. Hence, prioritysetting becomes a necessity for skilful rationing. I II III Since 1999, Israel has implemented a structured mechanism of annual updating of the National List of Health Services (NLHS="Basket") on the basis of the National Health Insurance Law (1998), incorporating clinical, economic, ethical, legal and social aspects. Safety & Efficacy Internal prioritization process : Effectiveness “Technology Forum” : Determining technology benefits “Auxiliary Committee” : IV Final recommendations for government approval are made by the National Basket Committee (representatives include physicians, insurers, clergy, ethicist and members of the public). V VI NIS* Basic regulatory approval by MOH : Focusing on pricing National "Basket" Committee : Recommendations for public funding Government approval : Final list of funded technologies Additions to the “Health Basket” 1995 -2009 Time Line January March April-May June-Aug Sept-Nov December Adjustments in the Israeli healthcare system: 700 · Emphasizing equity (accessibility to health services) · Improving epidemiologic data collection · Enhancing economic aspects (pricing & cost- effectiveness analysis) · Implementing ethical values: Saving lives, Quality of Life, “ Little for many” vs. “Much for few” · Reflecting public opinion Conclusion 1998 1999 2000 2001 2002 20032004 2005 20062007 2008 2009 150 255 196 220 60 370 700 450 415 1. 0 1. 5 1. 0 0. 25 1. 63 2. 88 1. 56 17 51 118 84 53 35 69 75 80 87 Addition Million NIS* Reviewing the past decade reveals a structured mechanism for updating the national publicly-funded healthcare basket. Flexibility in this dynamic process is essential for coping with evolving challenges. % Total Basket Cost No. Techno logies * $US 1 = NIS 4. 2 approx. Contact: ornat@gertner. health. gov. il