Three "inconvenient truths"
about Health Care link
(...) Much discussion of reform concentrates on covering the uninsured. This is a worthy goal, but without sustained attention to the cost of care, gains in coverage will not be sustainable.
(...) Much discussion of reform concentrates on covering the uninsured. This is a worthy goal, but without sustained attention to the cost of care, gains in coverage will not be sustainable.
(...) Advances in medicine are the main reason why health care spending has grown 2.8% per annum faster than the rest of the economy.
But advances in diagnostic and therapeutic interventions have been largely responsible for increases in the length and quality of life. How can we retain most of the health benefits of future medical advances while slowing the rate of growth of health care expenditures?
Part of the answer lies in the creation of a large, semi-independent organization — something like Britain’s National Institute for Health and Clinical Excellence — to evaluate the benefits and costs of new medical interventions. Such an organization must have a substantial budget, because new interventions flood the market every year and new applications of older technologies add to this problem.
It is not feasible for individual physicians or even large groups of physicians to carry out the necessary analyses, especially when estimates of costs and benefits are indispensable. Furthermore, the funding for such an organization must be relatively steady over time; funding based on the vagaries of annual Congressional appropriations have doomed previous governmental initiatives for technology assessment.
The other part of the answer is for health care organizations to be willing and able to incorporate the assessments into their daily practice. They must have the information, infrastructure, and incentives to deliver high-quality, cost-effective care. This does not mean that they must be fully integrated group practices. It does mean that they must create mechanisms, relationships, and processes to achieve the coordination of care that today’s patients and today’s health care technologies require.(...)
Victor R. Fuchs, nejm 23.10.08
But advances in diagnostic and therapeutic interventions have been largely responsible for increases in the length and quality of life. How can we retain most of the health benefits of future medical advances while slowing the rate of growth of health care expenditures?
Part of the answer lies in the creation of a large, semi-independent organization — something like Britain’s National Institute for Health and Clinical Excellence — to evaluate the benefits and costs of new medical interventions. Such an organization must have a substantial budget, because new interventions flood the market every year and new applications of older technologies add to this problem.
It is not feasible for individual physicians or even large groups of physicians to carry out the necessary analyses, especially when estimates of costs and benefits are indispensable. Furthermore, the funding for such an organization must be relatively steady over time; funding based on the vagaries of annual Congressional appropriations have doomed previous governmental initiatives for technology assessment.
The other part of the answer is for health care organizations to be willing and able to incorporate the assessments into their daily practice. They must have the information, infrastructure, and incentives to deliver high-quality, cost-effective care. This does not mean that they must be fully integrated group practices. It does mean that they must create mechanisms, relationships, and processes to achieve the coordination of care that today’s patients and today’s health care technologies require.(...)
Victor R. Fuchs, nejm 23.10.08
Etiquetas: USA election 08
2 Comments:
"Part of the answer lies in the creation of a large, semi-independent organization — something like Britain’s National Institute for Health and Clinical Excellence — to evaluate the benefits and costs of new medical interventions."
Em relação à introdução de novos fármacos ou de medicamentos inovadores, não passa de uma afirmação de Monsieur La Palisse.
O interessante é a classificação do NICE.
Uma organização "semi-independente"?
O que é isso?
Depende às 2ºs, 4ºs e 6ªs do MS e é independemte nos restantes dias?
Em que dias é que decide?.
Os avanços tecnológicos devem estar sujeitos a condicionantes. Mas, em Saúde, têm de se libertar, da governamentalização
Será difícil, num sistema público. Mas é a maneira de se tornar credível, distante das disputas político-económicas que os poderes medeiam, de responder atempadamente (não fazendo “economias de dilação”).
A não ser que uma organização semi-pública, tenha uma matriz pública e só possa actuar em “coisas” públicas.
Deste modo, liberta-se o emergente mercado de saúde privado de regras. Introduz-se, com este regime, o neo-liberalismo, com o risco de introdução de (princípios) activos tóxicos. Já demos para este peditório.
O problema é mais vasto. A Europa tem uma organização que se dedica a estes problemas. Chama-se: EORTC (European Organisation for Research and Treatment of Câncer), onde os ingleses estão representados embora com um pé dentro e o outro de fora (nationalists impudences).
Tal facto, tem travado o desenvolvimento desta agência europeia e proporcionado a manutenção do NICE (cujas decisões devemos reconhecer não estão isentas de polémica).
Na verdade, não se justifica a existência de organizações deste tipo dispersas por vários Países europeus. Há uma replicação de processos, avaliações sem sentido. Depois, discrepâncias de decisões, frequentemente mal explicadas ou sem qualquer justificação. Aparentemente inofensivas mas, degastante da confinça que os cidadãos deve ter na avaliação dos fármacos.
Cada Estado americano não replicou a “sua” FDA. O FDA é um organismo federal que vive (devria viver)dentro do Department of Health & Human Services, de modo autónomo.
A solução, no meu entendimento, está em apetrechar a EORTC para actuar com rigor e na procura da evidência científica na área oncológica e para os restantes fármacos a um comité de novos medicamentos na EMEA.
Embora, possuindo, sistemas de saúde diferentes esta “centralização” oferece mais vantagens do que a vacilante e dúbia ideia de semi-independente.
Que em Portugal se explicita do seguinte modo: nem é carne, nem é peixe…
Nota:
Existiriam outras considerações a colocar quanto á organização e recursos humanos destes organismos, mas ficam para outra oportunidade…
Greenspan admitted that he had put too much faith in the self-correcting power of free markets and had failed to anticipate the self-destructive power of wanton mortgage lending. link
NYTimes 24.10.08
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