Canadian Perspective on Health Technologies & Health Technology Assessment PDF

Canadian perspective on health technologies and health technology assessment HSS 4108 A Methods of Health Technology Assessment Week 2- September 11  What we learn today … Healthcare system in Canada Founding Principles...

Canadian perspective on health technologies and health technology assessment HSS 4108 A Methods of Health Technology Assessment Week 2- September 11  What we learn today … Healthcare system in Canada Founding Principles Healthcare Institutions Evolution in Healthcare system History of HTA September 11 HTA Organizations Emerging Trends Challenges of HTA in Canada 2  Founding Principles of Canada's Healthcare System Canada’s healthcare system combines public financing with private provision. Public financing began in 1947 with Saskatchewan’s universal hospital insurance By 1961, 99% of Canadians had free access to covered health services September 11 due to the Hospital Insurance and Diagnostic Services Act of 1957. However, physician services, notably outpatient services, remained largely uninsured. 3  Medicare System September 11 In 1964, a Royal Commission on Health By 1966, most Canadians were insured Services recommended a comprehensive for physician services through various and universal medicare system for all private or public insurance plans. Canadians, including coverage of physician care and prescription drugs. 4  Federal Structure The healthcare system is managed by thirteen provincial and territorial governments. Funded through a mix of provincial revenue, health taxes, and federal transfers. Universal coverage is provided for hospital and physician services, September 11 with private insurance banned for services covered by public funding. 5  Evolution Amid Constancy HC system needs to create balance between different aspects System’s Foundational Aspects Government Direction Aim to provide reports and evaluate health care systems and services provided to general public to create transparency and respond to consumers consumer attitudes influenced by media; problematic as Canadian and American HC systems are completely different Quality Councils Consumer Attitudes System Productivity and Dr.Charlie in Quebec: requested for running private hospitals in Quebec due to long time wait for HC services Legal Challenges Sustainability September 11 HC systems had to respond to ex. Doctor or nursing shortages needed to be responded to differently ex. Have other workers in HC to take on some of nurses responsibilities; however, shortage of doctors can’t be addressed in same way Physician-Government Provider Impact for doctors, make it easier for docs who studied outside Canada to get licensed here Relationship Negotiating over working conditions to make better decisions and improve patient outcomes 6  Health System Institutions and Constituencies HEALTHCARE 01 HOSPITALS 02 PHYSICIANS 03 SYSTEM BALANCE Not-for-profit Generally contractors Strives to balance organizations within a managing their own government direction, single-payer system with practices. consumer choice, and Provincial government global budgeting. Paid through a Physician receives specific provider autonomy. Create a monopsonistic combination of fee-for- Maintained through the amount of money for each visit market for hospital service and capitation or receives specific amount of money per patient regardless of principles of the Canada services. rostering payments. number of visits pt has during month/year Health Act of 1984: Hospital-based Hospital-based physicians Public September 11 healthcare workers may receive reduced-cost administration (except physicians) are or free office space in Comprehensiveness employed by hospitals. exchange for practicing at Universality Working conditions the facility. Portability often determined Few physicians are Accessibility through province-wide directly employed by collective bargaining. hospitals. 7 Factors Shaping Technology Adoption and Use Public Financing and HTA: Canada's single-payer system with public financing implicitly serves as a form of health technology assessment (HTA). This structure influences the introduction and use of new health technologies. By having a centralized payer system, the government naturally September 11 controls which technologies are introduced based on overall budget priorities, reducing unnecessary or overly expensive technology adoption. 8 Global Budgeting for Hospitals Provincial governments control hospital budgets, meaning new construction and technology adoption must be approved within a global funding envelope, limiting excessive competition over technologies. Each hospital receives specific amount of funds for a specific year; determined by needs of hospital; purpose is to limit unnecessary expenses Hospitals cannot act independently in technology acquisitions because operating costs need government approval, which ensures September 11 that resources are allocated according to need rather than competition. 9 Blunting Technology Competition: The global budget system reduces competition between hospitals to acquire the latest technologies, unlike in countries like the U.S., making high-tech arms races financially unsustainable. relly on private funding Global budgets create financial constraints, preventing hospitals from over-investing in new technologies purely for competition, ensuring cost-effective use of resources. September 11 10 Provincial HTA Bodies: By the 1990s, most provinces established HTA agencies to manage technology adoption more effectively, providing evidence-based input to policy decisions. September 11 The need for more targeted, informed decision-making on technology adoption led to the creation of specialized bodies to ensure that technologies provide value before they are widely implemented. 11 Physician Influence on Lower-Cost Technologies For low-cost technologies, physician influence plays a larger role in adoption, especially when direct billing to patients is possible. However, doctor shortages and regulatory barriers limit the spread of physician-driven services. Doctors can more easily adopt low-cost technologies that can be directly billed to patients, but structural constraints like physician September 11 shortages and fee regulations curb this entrepreneurial influence. 12  Professional and Technical Fees In some provinces, the separation of The division of fees discourages professional fees (for procedures) Paid to doctors physicians from adopting expensive and technical fees (for equipment) ex. Imaging device technologies because they cannot has limited the ability of physicians September 11 profit from equipment ownership, No private ownership to drive technology adoption which slows down physician-driven compared to systems with more adoption. private sector involvement. 13 Early history of HTA in Canada Key challenges about adopting tech in Canada: time it takes to assess a tech to prove it is effective to be implemented in HC systems, population & technology users (ability to use the tech; solution in HTA is to evaluate experience of pt using the tech; integrate their experiences w/ tech into HTA framework September 11 14 Favorable Environment for HTA in Canada: HTA emerged in a positive climate due to the predisposition of clinicians, patients, and managers toward health science, and the limited presence of health technology developers in Canada. September 11 The absence of strong domestic producers meant there was less commercial pressure on HTA decisions, allowing it to focus on optimizing public spending 15 First HTA Body in Quebec (CETS) The Conseil d’évaluation des technologies de la santé (CETS) was established in 1988 to assess health technologies and advise the Quebec government. September 11 This body was a pioneering initiative aimed at improving decision- making around the adoption of health technologies in Quebec. 16 Evolution of CETS to AETMIS HTA agency in quebec In 2000, CETS became AETMIS, broadening its role to evaluate health technologies and intervention methods. This transition reflected a growing emphasis on comprehensive health assessments that go beyond technologies to include healthcare interventions. Creation of CCOHTA: The Canadian Coordinating Office for Health Technology Assessment (CCOHTA) September 11 was founded in 1989 after an interprovincial symposium to promote HTA across Canada. This national body aimed to coordinate HTA efforts among provinces, particularly benefiting smaller provinces with limited capacity for independent assessments. 17 Pan-Canadian Efforts CCOHTA to CADTH: In 2006, CCOHTA became CADTH (Canadian Agency for Drugs and Technologies in Health), expanding its mandate to include drug reviews and optimal medication use. CADTH’s broader scope addressed a need for comprehensive September 11 assessments that include both technologies and medications, improving policy-relevant research. 18 Provincial Initiatives BCOHTA Establishment and Closure: The British Columbia Office of Health Technology Assessment (BCOHTA) was created in 1990 but was closed in 2002 due to government budget cuts. BCOHTA sought to explore the social implications of health technology but was discontinued when budget priorities shifted, demonstrating the financial vulnerability of HTA programs. Alberta’s HTA Program: September 11 Alberta established an HTA program in 1993, which was later transferred to the Alberta Heritage Foundation for Medical Research and then to the Institute of Health Economics (IHE) in 2006. Alberta’s HTA efforts have been sustained and evolved over time, showing the province's long- term commitment to integrating HTA into healthcare planning. 19 Evolution of HTA and Emerging Trends in Canada September 11 20 Growth of HTA Organizations Diverse HTA Models Over time, the number of HTA (Health Different provinces and Technology Assessment) organizations has territories use varying HTA increased across Canada. HTA has gained models, reflecting their unique influence in policy-making, supported by healthcare systems. These federal commissions recommending its models include government- expansion to ensure optimal use of public supported, academic, and resources in healthcare decisions. September 11 hospital-based HTA organizations, contributing to a diverse landscape of health technology evaluation. 21 Emergence of Hospital-Based HTA Hospital-based HTA efforts have increased, embedding HTA as a permanent feature of healthcare decision-making in Canada. Institutions like Quebec’s academic health centers are required to have HTA capacities, indicating HTA’s growing role at the institutional level. Broadening HTA Scope Quebec’s creation of INESSS, which combines the assessment of drugs and health technologies while integrating social services, highlights an September 11 expanded view of technology assessment. This broader approach shows HTA’s maturing tools and its deeper influence on healthcare decisions. 22  The National Health Technology Strategy has been developed to National coordinate HTA information and guide provincial decisions. CADTH Health has introduced services like Technology inquiry response and liaison Strategy programs to enhance information sharing across provinces. September 11 23 Managed Diffusion of Technologies HTA has helped in managing the diffusion of health technologies, ensuring cost- effectiveness while delaying rapid September 11 adoption. This approach allows governments to benefit from lower costs associated with later adoption and risk reduction from more informed decisions. 24 Canadian Consumer Awareness Despite HTA’s growing role in decision-making, Canadian consumers have remained largely unaware of its direct impact. Proximity to the U.S. offers a contrast between market-driven and public financing models, providing Canadians with alternative perspectives on healthcare technology. Pharmaceutical vs. Technology Policy There is a notable divergence in policy responses to pharmaceuticals and other health technologies. Pharmaceuticals, through the Common Drug Review process, have seen more collaboration among provinces, possibly September 11 due to the more concentrated industry presence and clearer cost structures. 25 Future of HTA HTA is expected to further strengthen its academic foundation as government decision-makers increasingly embrace evidence-based frameworks. There is potential for greater integration between HTA organizations, funding bodies, and public health initiatives, which could enhance research capacity and training. September 11 26 Challenges for the future of HTA in Canada More meaningful involvement Understanding and defining of patients in health the value of a health technology assessment and technology; decision-making processes; September 11 Dealing with a fragmented Addressing companion system of health technology diagnostics and personalized assessment for nondrug medicine technologies; and 27 Current Challenges of HTA Defining the value of technology and addressing biases in decision- making. Engaging patients in the health technology assessment process. Variability in nondrug health technology assessment across jurisdictions. September 11 Addressing companion diagnostics and personalized medicine challenges. 28 References Battista, R. N., Côté, B., Hodge, M. J., & Husereau, D. (2009). Health technology assessment in Canada. International Journal of Technology Assessment in Health Care, 25(S1), PP 53-60. OECD. (2005). Health Technology and Decision Making. OECD. September 11 29