16th International EBHC Symposium
What has health care learnt from the COVID-19 pandemic?
4-5 października 2021 | ONLINE
16th International EBHC Symposium
What has health care learnt from the COVID-19 pandemic?
4-5 października 2021 | ONLINE
16. Międzynarodowe Sympozjum Evidence-Based Health Care pt. “What has health care learnt from the COVID-19 pandemic?” ze względu na pandemię COVID-19 odbyło się online w dniach 4-5 października 2021. Mamy nadzieję, że to już ostatnia edycja naszego Sympozjum, która odbywa się w reżimie epidemicznym. Nagrania wystąpień są dostępne na naszym portalu streamingowym: live.ceestahc.org
The programme of the 16th EBHC Symposium was held over the course of 2 days in the following thematic blocks:
- Drugs - from market authorization to across reimbursement
- Quality = increase the likelihood of desired health outcomes
- Health care as one the health determinants
- Evidence - RCT … RWE
- System transformations - from ... to digital health care
- Health policy challenges in the local governments
- Successes and challenges in SMA patient care
Organised since 2006, the EBHC Symposium has become a permanent fixture on the conference calendar, also attracting participants from other countries. It is a place for unconstrained discussions on the assessment of health technologies and the effectiveness of systemic solutions. Inevitably, our Symposium has also become a platform for discussing the shape of the Polish healthcare system.
In 2020 and 2021, our entire modern world has experienced a threat which for several generations no longer seemed real. A ubiquitous threat to life, being locked up at home and lack of access to many consumer conveniences and achievements of civilisation have demonstrated how fragile our existence can be. A pandemic wave flooded the world and shattered the existing image of our civilisation.
In Poland, as elsewhere in the world, health care turned out to be the most burdened element, as it yielded to the wave, but did not collapse. In our opinion, this is the sole merit of dedicated employees: doctors, nurses, paramedics and support staff who, despite the threat to health, technical complications, decision chaos and media attacks, continued to do their job the best.
Pandemia jak tsunami bezlitośnie obnażyła wszystkie trwające od lat niedociągnięcia w planowaniu, organizacji czy finansowaniu świadczeń. Po tym potopie wyłoni się nowy krajobraz, w którym solidne elementy systemu opieki zdrowotnej będą nadal trwały. Pojawi się też miejsce na odbudowę tych które nie przetrwały próby. I o tym właśnie dyskutowaliśmy w czasie 16. edycji naszego Sympozjum.
16th International EBHC Symposium
What has health care learnt from the COVID-19 pandemic?
4-5 października 2021 | ONLINE
16th International EBHC Symposium
What has health care learnt from the COVID-19 pandemic?
4-5 października 2021 | ONLINE
- Session 1: Drugs - from market authorization to across reimbursement
- Session 2: Quality = increase the likelihood of desired health outcomes
- Satellite session: Successes and challenges in SMA patient care
- Session 3: Health care as one the health determinants
- Session 4: Evidence - RCT … RWE
- Session 5: System transformations - from ... to digital health care
- Session 6: Health policy challenges in the local governments
Universal coverage is a hallmark of governments' commitment to improving the well-being of all citizens. Universal coverage is based on the WHO Constitution of 1948, resulting in the recognition of health as a fundamental human right, and the Alma Ata Declaration of 1978, which established the concept of Health For All (HFA). Drug reimbursement is one of the elements of the basic benefit package (BBP), guaranteeing patients access to drug technologies to improve their health. In many European countries (the Netherlands, England, Italy, Belgium) and worldwide, new solutions are being implemented to extend the monitoring of the healthcare system beyond the financial aspects. For modern and flexible healthcare management to be possible, data are needed on the population's health status or the quality of prescribing, as well as monitoring of clinical outcomes for new innovations entering the market. Thanks to widespread computerisation, even basic patient registration results in the collection and accumulation huge amounts of data. This creates the problem of merging data sets, data processing and drawing conclusions. There is certainly still a long way to go before a systemic shift is made from information collected from the country's entire population to the response of the reimbursement system. During this session we will hear about the attempt to set up such a system on the example of the UK drug reimbursement model – from strategic goals to tools for monitoring and evaluating the performance of the system.
In Poland, the Act on Reimbursement, in force since 2012, has introduced a certain order to the drug reimbursement system by adapting it to European standards. The Act has also implemented many modern solutions to improve the availability of drugs, such as tools for rationalisation of systemic decision-making, sets of reimbursement criteria, formalised price negotiations, mandatory HTA and risk-sharing instruments. The new Act on Reimbursement made it possible to provide reimbursement coverage to many modern medicinal products, regardless of indications or availability categories. The Medical Fund introduced in 2020 and the amendment of the Act on Reimbursement are meant to be the answer to delays in reimbursement coverage. In this session we will learn about 10 examples of changes in the Polish healthcare system and the role that the Agency for Health Technology Assessment and Tariff System played in them.
Quality in healthcare is a systematic process that enables the design and implementation of effective interventions to improve clinical outcomes by enhancing the range and standard of services. Over many decades, numerous solutions have been developed and experience in improving the quality of healthcare has been accumulated. Despite this wealth of knowledge, a problem often faced by national policy makers in both high and low gross domestic product countries is knowledge of which quality-related strategies would have the most beneficial impact on the outcomes of their healthcare systems. The quality strategy must not only bring about quality improvement, but must also be implementable in the existing healthcare system and have mechanisms in place to monitor the effects of quality improvement. Even where healthcare systems are well developed and equipped, quality remains a major problem and the achieved results are variable and unpredictable. Differentiation in terms of standard occurs at every level: between both healthcare providers within a country and between countries.
People, especially healthcare system managers, play a key role in building and maintaining quality. There is a huge amount of local actions aimed at quality improvement in most countries, but often these activities are carried out in an inadequate political environment and never reach a strategic level. Creators of local solution make decisions based on their competences and the needs of their environment. It is wrong to assume that one solution is adequate for the needs of all patients e.g. sharing a particular condition. For this reason, few local solutions can be scaled-up. Quality building based on the needs of the local healthcare organisation is also easier and carries a lower risk; therefore it is feasible to implement, for example, in developing countries. In these countries, quality improvement is mainly done by increasing healthcare coverage in the population (universal coverage), therefore local quality-improvement strategies with extensive objectives characterised by low complexity can be scaled-up (to a regional or national level).
During this session, the following issues from the Polish healthcare system will be presented: improving patient safety, proposed solutions in pulmonary care and monitoring health effects in breast cancer treatment.
Spinal Muscular Atrophy (SMA) is a genetic neurodegenerative disease affecting motor nerve cells in the spinal cord. It is characterised by progressive wasting of muscles, taking away the patient’s ability to walk, eat or breathe. It affects both newborns and older children or adults. Due to its progressive nature, SMA leads to a significant reduction in the quality of life of patients and their families, being the source of both a psychological and economic overburden. In recent years, significant advances have been made in the research and treatment of SMA.
One of the issues discussed during this session is the national SMA newborn screening programme, given as an example of the medical environment and a social initiative's joint success. Guests of this session will also discuss challenges for the system in SMA patient care based on the “Time is Motor Neuron” report which was developed by a multidisciplinary group of experts.
Social determinants of health (SDoH) social determinants of health, SDoH) to stosunkowo nowy termin w opiece zdrowotnej. Zgodnie z definicją Światowej Organizacji Zdrowia (WHO), SDoH to “warunki, w których ludzie rodzą się, rosną, żyją, pracują i starzeją się. Okoliczności te są kształtowane przez dystrybucję pieniędzy, władzy i zasobów na poziomie globalnym, krajowym i lokalnym”. Zdrowie determinuje również dostęp i jakość opieki medycznej – czasami określane jako medyczne społeczne uwarunkowania zdrowia.
While the pathogens themselves might not discriminate against anyone, social conditions do. The very perception of a given illness depends strongly on whether the general public thinks it results from an unfortunate coincidence or a particular person’s negligence. Every day, COVID-19 morbidity and mortality data reveal how much injustice there has been among the various patient groups; they have been making differences in health outcomes for a long time, and during the pandemic, they could determine if someone lives or dies. The COVID-19 pandemic highlighted that precarious work and exploitative and unfavourable working conditions intersect with a number of factors, including education, socio-economic class and gender, or dependence on third parties (persons with disabilities, people in residential care). The overlapping of these factors increases the risk of contracting a COVID-19 infection in certain groups, as well as the risk of a severe course of the infection. The reduction in access to care for chronically ill patients will have long-term consequences, including those who have managed to avoid contracting COVID-19.
During this session, opinions will be presented on the consequences of the pandemic in the UK, the development of access to genetic testing in Poland, the importance of inequalities, and the evaluation of patient experience in health care.
In recent years, technological developments have helped increase our capacity to collect real-world data (RWD) from the health care system, and the introduction of artificial intelligence (AI) tools helps create real-world evidence (RWE). Scientists, physicians, and public institutions are improving their strategies of integrating RWE into their decision-making processes.
The COVID-19 pandemic imposed the need for a prospective analysis of data flowing from various players in the health care system and accelerated the implementation of solutions. This session will present, among others, Swedish ideas for legal empowerment and an efficient analysis of data from national registers, which were implemented for health care management during the COVID-19 pandemic.
Before the COVID-19 pandemic, RWE data were rarely considered in the decision-making process – especially in analyses performed by HTA agencies. Six of the 13 agencies limited the use of RWE because of a strict hierarchy of evidence, with randomised controlled trials (RCTs) at the top for years. This was the case despite most HTA agencies’ declarations that they accept all evidence on drug efficacy – and therefore, in theory, also RWE in their methodological guidelines.
Systems are now slowly moving towards a change in the approach, and the use of RWE results is becoming more widespread. That way, this new tool will not just be the subject of declarations but actual use. In December 2020, the UK’s NICE published new guidelines on RWE assessment. In turn, the German Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, IQWiG) has already officially started accepting findings from reliable registers – however with the exclusion of analyses based on electronic health records (EHR). This session will focus on evaluation methodologies using AI, the range of health outcomes evaluated in haematology-oncology, and the potential for innovative drug evaluation solutions.
Digital transformation in the healthcare system means a positive influence of technology on health care. Telemedicine, Ai-based medical equipment and electronic medical records (including blockchain) are only a few specific examples of the digital transformation observed in health care. They are revolutionising the way we interact with healthcare professionals, how our data is shared to healthcare providers and how the decisions regarding our treatment plans and medical results are being made.
Innovation in this field means not only improving doctors’ work and optimising systems, but more importantly improving patients’ results, safety (e.g. less human errors) and economic efficiency of the systems. During this session, examples of digitalisation solutions in Spain, Croatia and USA, including the examples implemented during the COVID-19 pandemic, will be presented.
As was the case with past editions of the EBHC Symposium, CEESTAHC continues to collaborate with local governments and to cover local-government-related topics.
The COVID-19 pandemic has caused a dire crisis and we are all experiencing its effects. As a complementary stakeholder responsible for diagnosing the health situation and responding to local needs, the local government has found itself on the front line of this extraordinary situation. And at the beginning of the pandemic, when the situation was rapidly changing, when procedures, law and logistics were not keeping up with the virus, it often stood on this front line alone. In their dramatic calls for assistance, local government officials were insisting on guidelines, procedures and efficiency analyses from the Polish healthcare system decision-makers.
Simultaneously, for a long time (since 2009, following the relevant changes in law), the projects of health policy programmes, as sets of planned interventions (health technologies), have been evaluated by a central institution responsible for health technology assessment. In this case, the pressure to meet the planning and efficacy needs is coming from the top (causing initial discontent of some local governments).
These two seemingly irreconcilable approaches have a common denominator: effective pro-health actions. Nowadays, when healthcare budgets are getting tighter, decisions should be based on substantive, robust foundations, such as epidemiological data, expert guidelines and scientific evidence to an even greater extent. However, local governments' access to available data is a sensitive topic in Poland, because until recently it was hard to find synthetic overviews which would be helpful in retrospective analyses or in planning successful projects. What is problematic are the legal and technical obstacles standing in the way of merging the existing databases and sharing the analyses results in a form that would be useful for entities responsible for planning and implementing actions. Health needs maps and ProfiBaza can change this situation.
During this session we will find out what Heath Technology Assessment (HTA) has to offer public health programmes in Europe. The barriers of implementing HTA into public health programmes will be presented on the example of COVID-19 vaccinations.
When discussing the situation in Poland, we will take a look at the circumstances affecting local governments pursuing health policies when faced with the COVID-19 pandemic and its effects. We will check what has changed over the last two years and how health priorities have shifted.
Local governments are sending a decreasing number of health policy programme drafts to AOTMiT, even though risk group patients are in need of greater support and involvement of all institutions, both central and local. Low vaccination rate, ostracism and reduced social and physical activity of senior citizens, havoc in children’s and teens’ bodies after a year of remote education in front of computer, or the healthcare system's general inefficiency – these are only some of the challenges encountered by local governments.
One of the key challenges which public health needs to confront is providing care to patients who recovered from COVID-19. This is where physiotherapists' work is invaluable. Local governments are physiotherapists’ natural allies for any activities aimed at keeping people fit – both healthy citizens and survivals of various injuries or diseases (including COVID-19). Health policies can be adjusted by actions taken locally. Local governments have been proving it for years with their programmes. That is why the Polish Chamber of Physiotherapists (KIF) collaborates with local governments. Effects of KIF’s work include a physiotherapy programme in the process of comprehensive rehabilitation for COVID-19 convalescents – AOTMiT based its programme for local governments on its basis.
Final Programme
Prezentacje wykładów 2020
Nagrania wykładów 2020
English (UK) 
Polski