COMPARISON OF REIMBURSEMENT SYSTEMS:

TURKEY & GERMANY & UK Çağıl Görkey TURGUT, Funda ÖZDİLER, İsmet KÖKSAL, Osman Arıkan NACAR, Ercan ŞİMŞEK

Republic of Turkey Ministry of Health Medicines and Medical Devices Agency, Department of Medical Devices, Ankara, TURKEY

INTRODUCTION

Health technology assessment (HTA) is an interdisciplinary process that summarizes and provides medical, social, economic and ethical information about the use of technology in a systematic, transparent and impartial manner. The main purpose of HTA is to provide information in order to obtain efficient, patient focused and safe health care policies. In Turkey, there was a 21% increase in healthcare payments made by the public institutions, and peaked at 22 million dollars in 2012. In order to reduce health care payments, HTA plays a crucial role. Within this respect, two new departments have been established under Ministry of Health and Social Security Institution to implement evidence-based health care pricing policy and produce high quality assessment reports. A pilot project has been undertaken, using published sources and visiting equivalent agencies. In this study, a detailed comparison between Turkey, Germany and the UK’ reimbursement systems has been provided.

UNITED KINGDOM

TURKEY

References:[1] http://webstore.haywardpublishing.co.uk/index.php?route=product/product&product_id=76 [2] http://lillypad.eu/public-policy.html [3] http://www.eucmed.com

Key Decision Makers and Influencers in Funding Healthcare

• Assesses & Buys vast mojority of devices

•Regulatory (CE Marking)

• Funding

• HTA (Value for money at the national level)

NICE PCTs

NHS MHRA

Reimbursement System

Drugs and medical devices are part of HRG costs but there are high cost drugs and medical devices, as certain other products, that have been excluded from HRG’s.

For patients to access medical devices in community care setting they, typically, have to be “prescribed” by a health care practitioner. Therefore, the reimbursement process requires a medical device manufacturer to apply, to have their product listed on the Drug Tariff. This process involves requesting a price and justifying this price with evidence, data, etc.

In certain industry sectors, e.g. woundcare, the prescription process is being circumvented. To control prescribing clinicians and managers in Primary Care Trusts (PCTs) are not issuing prescriptions but purchasing products directly or via wholesalers and distributors against their prescribing budgets.

GERMANY

Overall Reimbursement System

Reimbursement of Inpatient Hospital Products Health technology assessment (HTA) is a multidisciplinary activity that systematically examines the safety, clinical efficacy and effectiveness, cost, cost-effectiveness, organisational implications, social consequences, legal and ethical considerations of the application of a health technology – usually a drug, medical device or clinical/surgical procedure[1].

What is HTA?

[2] Focus of a HTA process

Healthcare & Funding System

• The Turkish Healthcare system is largely publicly oriented with increasing private sector involvement

• MoH is the main body responsible for healthcare services

• Social Security Instutition (SSI) managed by a general assembly, board of directors,and president

• Primarily single public payer system (SSI)

• 2011-2013 system: Procedure fees + selected medical device payments

• FUTURE: Fee-for-service payments, DRG like mechanism in 2013

• HTA implementation in progress at MoH and SGK (clinical & cost effectiveness)

• SGK announced SUT-positive reimbursement lists for branchs. Public and private providers created aggrements accordingly.