Decision makers who undertake health technology assessments such as those conducted by NICE, deliberatively consider a new technologies cost per QALY, alongside other criteria (such as, equity, whether treatment is lifesaving and patient experience, etc) which are not captured in incremental cost-effectiveness ratios alone. The intention to implement an explicit value based pricing scheme in the United Kingdom in 2014 has sparked a debate regarding which elements should be included in the assessment of value and how they should be combined and traded-off against each other. Of importance is consideration to how values should be derived to determine how different criteria should trade-off each other. This debate is timely given that even where price is considered to be fixed during the re-imbursement process (such as the current NICE process) such systems could be seen implicitly determining value based price and may influence pricing decisions. Using an example presented in a recent review or multi-criteria decision making (Thokala 2011) we compare four mechanisms by which different elements of value could be explicitly and deterministically traded-off in order to provide an overall estimate of a value based price.The mechanisms are:conventional cost per QALY; MCDA; adjusted QALY approach; adjusted threshold approach; and a net benefit approach. Hypothetical criteria incorporated into the decision making process include equity, innovation, patient compliance and the quality of evidence.Using these examples, we show that these methods are clearly related in that they ultimately require estimates of monetary value to be placed on each dimension of value, but may place different emphasis on the weightings given to specific elements and the potential interactions between different elements. The mechanism in which these monetary values are derived, must importantly reflect societies values in trading off additional criteria for overall health gains. OBJECTIVES:Under the concept of pharmaceutical branch development (2011-2020), social reimbursement system is going to be developed and implemented in Ukraine. That will demand a use of central health technology assessment (HTA) approach with appropriate instruments for its implementation. The aim of this publication was to develop an instrument for HTA prioritization in Ukraine by using qualitative approach. METHODS: A literature search was performed across PudMed, Medline, and Cochrane. EUR-ASSESS report was analyzed. Factors important for current health care decision making, data availability, and criteria important for prioritization in the other countries were reviewed by the experts and assessed on their applicability in Ukrainian health care setting. RESULTS: A list of criteria that should be a basis for HTA prioritization in Ukraine was developed. The criteria have different weight in accordance to their importance and data availability. These criteria are the following: burden of disease, current size of state financing for this health care branch, potential benef...
The resulting criterion of assessment of staff management effectiveness in health protection institution is a satisfaction of medical workers with their work. So, it is important to know the predictors of satisfaction and dissatisfaction with the work. The aim of the research was in determination of the predictors of satisfaction and dissatisfaction with the work in medical institution. There was carried out the interrogation of 395 doctors (52 %) and hospital nurses (48 %) of the institutions of Kyiv city (Ukraine) by the form (response 81 %), formed of 12 questions and 3 answers “Yes”, “No”, “Not decided) (α of Cronbach 0,82). Pearson’s consent coefficient (χ2) was used for determination of the differences in the answer structures. The reliable difference in the index of general satisfaction of doctors (95 % DІ: 69,87 %; 76,31 %) and hospital nurses (95 % DI: 70,10 %; 75,39 %) was not revealed. Analogously there were not revealed such differences in the index of general dissatisfaction of doctors (95% DІ: 17,97 %; 24,09 %) and hospital nurses (95 % DІ: 16,76 %, 21,80 %). The structures of answers to the question about patients’ attitude did not reliably (р<0,05) differ (94,12 % of doctors, 79,52 % of hospital nurses answered “YES”), about improvement of medical help at material stimulation by patients (20 % of doctors, 13,25 % of hospital nurses – “YES”), about the choice of own profession again (41,18 % of doctors, 20,48 % hospital nurses – “NO”). It was determined that the predicators of medical workers’ satisfaction with their work are an attitude of colleges, patients, leader, climate in collective, and the ones of dissatisfaction – a salary, management system, labor conditions.
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