Can Politics and Ethics be Reconciled?
Are public health systems that offer universal care affordable and financially sustainable?
The European Union can pride itself with the eldest and more universal form of Public Healthcare systems, that offers "free" health care to all the pupulation, regardless of employement status, gender, age or socioeconomic status. Tax payers are ultimately resposnsible for the sustainability of the system, as well as other key aspects of "welfare", like pensions and education. The system has created a social stability and social justice unprecedented in the world, but, while in the USA the issue is likely to become a rather important one in the next Presidential elections and in forthcoming years to give more stability to the overstressed American middle class, in the EU the issue is double:
a) are tax payers getting "good value for money"?
b) is the system sustainable when economic growth has declined in most countries to below 2%?
One example is the current debate in Italy regarding cardiac defibrillators that can save lives when implanted into the heart of patients at high risk of fatal cardiac arrythmias and sudden death:
"Italian finanziaria is harming patient care" - Medtronic weighs in with ICD data
Italy implanted 13,000 defibrillators in 2006, against a demand of 246,000, according to Medtronic. The figures, just released, are being used by the firm to underline what Italy's entire medical technology industry perceives as the hugely damaging impact of financial constraints being imposed on it through the annually-updated budgetary law - or finanziaria.
The figures speak for themselves with regard to access barriers, but in a statement distributed by industry association Assobiomedica, Medtronic claims that the number of patients awaiting an ICD conceals an estimated 57,000 avoidable early deaths per year and high additional costs to the national health service (SSN). These would be averted by simply adopting an "appropriate and forward-looking policy of investment in healthcare", it argues.
"The budgetary restrictions introduced by the finanziaria are leading to a policy of standardisation in the purchasing of medical devices and diagnostics, based on a logic of lowest prices that is counter to both patient care and product development," said Medtronic in the statement.
Throughout this year, Assobiomedica has been warning against the standardisation drive that is resulting from the latest round of cost-containment measures. These feature the requirement on the part of the regional health services and suppliers to produce for the central government details of all devices that account for the top 50% of medtech supply costs in each region (see Clinica No 1245, p 9).
The move is aimed essentially at compiling a list - nomenclatore - of essential technologies, to help the regional authorities lower their medtech supply costs. But device and diagnostic supplies to the SSN totalled only around Euro4bn ($5.7bn) in 2006, compared with Euro17bn for pharma, argues the association, noting the disproportionately small savings that the measures seek, in relation to overall healthcare spending.
Assobiomedica's anger at the plans erupted at last month's DiaBioTech conference, its annual debate with medical experts, regional healthcare managers and policy-makers. In a bid to avert the long-term damage to the industry of such "adverse selection" policies, the association used the event to underline the urgency of introducing two key initiatives:
* the establishment of a national pricing observatory, with a remit to monitor and regulate the operation of the medtech supply market, in a way that takes better account of the range of factors that affect purchasing decisions. On the one hand, it should: be sensitive to the specific nature of the sector, such as the multitude of characteristics that different models of the same device can offer; and appreciate the added value associated with medtech products, such as pre- and after-sales support. On the other hand, it should operate on a region-by-region basis, observing local economic and other conditions, while addressing national interests; and
* the formal introduction of health technology assessment (HTA), in a way that supports the "most appropriate use of medical technologies, thus informing purchasing policies". The project is being proposed by Assobiomedica as operating centrally, while liaising with, and overseeing, regional HTA-related activities.
The sense of urgency regarding these initiatives is palpable. Invigorated by its recent change of status from an association into a "top-flight" federation of the powerful pan-industrial confederation, Confindustria, together with the recent incorporation of the electromedical sector (see Clinica No 1273, p 1), it is currently channelling all its energies into persuading the government to reconsider its cost-containment strategy.
The 2008 finanziaria, which will attach new measures to the healthcare budget, is undergoing final drafting before imminently going to the Senate. It will then be the subject of debate between its two parliamentary houses, for publication by the end of the year.
Full Title: CLINICA - World Medical Technology News - http://www.clinica.co.uk
a) are tax payers getting "good value for money"?
b) is the system sustainable when economic growth has declined in most countries to below 2%?
One example is the current debate in Italy regarding cardiac defibrillators that can save lives when implanted into the heart of patients at high risk of fatal cardiac arrythmias and sudden death:
"Italian finanziaria is harming patient care" - Medtronic weighs in with ICD data
Italy implanted 13,000 defibrillators in 2006, against a demand of 246,000, according to Medtronic. The figures, just released, are being used by the firm to underline what Italy's entire medical technology industry perceives as the hugely damaging impact of financial constraints being imposed on it through the annually-updated budgetary law - or finanziaria.
The figures speak for themselves with regard to access barriers, but in a statement distributed by industry association Assobiomedica, Medtronic claims that the number of patients awaiting an ICD conceals an estimated 57,000 avoidable early deaths per year and high additional costs to the national health service (SSN). These would be averted by simply adopting an "appropriate and forward-looking policy of investment in healthcare", it argues.
"The budgetary restrictions introduced by the finanziaria are leading to a policy of standardisation in the purchasing of medical devices and diagnostics, based on a logic of lowest prices that is counter to both patient care and product development," said Medtronic in the statement.
Throughout this year, Assobiomedica has been warning against the standardisation drive that is resulting from the latest round of cost-containment measures. These feature the requirement on the part of the regional health services and suppliers to produce for the central government details of all devices that account for the top 50% of medtech supply costs in each region (see Clinica No 1245, p 9).
The move is aimed essentially at compiling a list - nomenclatore - of essential technologies, to help the regional authorities lower their medtech supply costs. But device and diagnostic supplies to the SSN totalled only around Euro4bn ($5.7bn) in 2006, compared with Euro17bn for pharma, argues the association, noting the disproportionately small savings that the measures seek, in relation to overall healthcare spending.
Assobiomedica's anger at the plans erupted at last month's DiaBioTech conference, its annual debate with medical experts, regional healthcare managers and policy-makers. In a bid to avert the long-term damage to the industry of such "adverse selection" policies, the association used the event to underline the urgency of introducing two key initiatives:
* the establishment of a national pricing observatory, with a remit to monitor and regulate the operation of the medtech supply market, in a way that takes better account of the range of factors that affect purchasing decisions. On the one hand, it should: be sensitive to the specific nature of the sector, such as the multitude of characteristics that different models of the same device can offer; and appreciate the added value associated with medtech products, such as pre- and after-sales support. On the other hand, it should operate on a region-by-region basis, observing local economic and other conditions, while addressing national interests; and
* the formal introduction of health technology assessment (HTA), in a way that supports the "most appropriate use of medical technologies, thus informing purchasing policies". The project is being proposed by Assobiomedica as operating centrally, while liaising with, and overseeing, regional HTA-related activities.
The sense of urgency regarding these initiatives is palpable. Invigorated by its recent change of status from an association into a "top-flight" federation of the powerful pan-industrial confederation, Confindustria, together with the recent incorporation of the electromedical sector (see Clinica No 1273, p 1), it is currently channelling all its energies into persuading the government to reconsider its cost-containment strategy.
The 2008 finanziaria, which will attach new measures to the healthcare budget, is undergoing final drafting before imminently going to the Senate. It will then be the subject of debate between its two parliamentary houses, for publication by the end of the year.
Full Title: CLINICA - World Medical Technology News - http://www.clinica.co.uk
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