How Managed Entry Agreements can improve allocation in the public health system: a mechanism design approach

Brammli‐Greenberg, Shuli; Yaari, Ira; Daniels, Elad; Adijes-Toren, Ariella

doi:10.1007/s10198-021-01284-2

Cited by 2 publications

(2 citation statements)

References 19 publications

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“…More than half (57%) of respondents in a random representative survey of Israeli adults reported the need to see a specialist in the last 6 months. This is consistent with the 59% of respondents who reported visiting a specialist in a 2018 Israeli survey (10) and is similar to the 60% of patients who had seen a specialist in the last 2 years in a Canadian patient survey (11). The vast majority of respondents (82%) in the current survey who expressed a need were able to get an appointment and had seen a physician by the time of the survey.…”

Section: Discussionsupporting

confidence: 85%

Factors Affecting the Patient Journey in Scheduling a Specialist Appointment in a Public Healthcare System

Luxenburg

Myers

Ziv

et al. 2022

Journal of Patient Experience

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A questionnaire was developed to evaluate the journey experienced by patients from identifying a need to see a community specialist in Israel's public healthcare system, through scheduling an appointment and attending. A telephone survey was conducted with a nationally representative group of 3751 adults, in 2019 to 2020. Fifty-seven percent needed to see a specialist in the last 6 months; among those, 82%, visited a specialist. Among the 3% who did not make an appointment, in 41 of 52 (79%) cases this was due to long waiting time. Younger and more educated patients were more likely to try to get an earlier appointment. Timeliness (55%) and wanting a specific physician (43%) were major considerations in scheduling. Reported need was greater in females, Jewish versus Arab respondents, more educated and those with chronic illness. Those who did not make an appointment sought private care, emergency treatment, or went untreated. Although a large percentage of respondents did eventually get an appointment, vulnerable patients may have more difficulty navigating the system. Following the patient journey can provide insights to help design services better suited to patients’ needs.

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Section: Discussionsupporting

confidence: 85%

Factors Affecting the Patient Journey in Scheduling a Specialist Appointment in a Public Healthcare System

Luxenburg

Myers

Ziv

et al. 2022

Journal of Patient Experience

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“…An analysis of risk-sharing agreements between 2011 and 2018 found that in 44 percent of said agreements, actual utilization exceeded the pre-specified threshold leading to the HMOs receiving reimbursement from pharmaceutical companies (16). Marketing authorization holders may submit risk-sharing models, such as managed entry agreements (17), which are brought for consideration before a subcommittee and the best model chosen. Computerized data from the HMOs on the degree to which the new technologies are implemented and utilized, and the budget allocated for technologies used, allows for periodic monitoring and fine-tuning.…”

Section: Resultsmentioning

confidence: 99%

Priority setting for health technology adoption at the national level: Lessons learned over 25 years’ experience

Luxenburg,

Morginstin,

Myers

et al. 2023

Int J Technol Assess Health Care

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Background Limited health budgets and continual advancement of health technologies require mechanisms for prioritization. Israel, with a publicly funded health service basket, has implemented and optimized such a health technology assessment process since 1999. We describe the process of evaluating technologies according to the Israeli model, analyze its outputs and benefits over two decades of implementation, and compare its key features with international experience. Methods Retrospective data were collected between 1998 and 2023, including work processes, committee composition, number of applications submitted and approved by a clinical domain, and yearly cost of the basket. Features were evaluated within the evidence-informed deliberative process (EDP) framework. Results This national model involves relevant stake holders in a participatory and transparent process, in a timely manner, and is accepted by the public, health professionals, and policy makers, facilitating early adoption of the newest medical technologies. Between 11 and 19 percent of applications are approved for reimbursement annually, mostly pharmaceuticals. On average 26 percent of approved technologies are added to the list without additional budget. Major domains of approved technologies were oncology, cardiology, and neurology. Conclusions Israel created a unique model for the expansion of the health service basket. Despite an increasing number of applications and rising costs, the mechanism enables a consensus to be reached on which technologies to fund, while remaining within budget constraints and facilitating immediate implementation. The process, which prioritizes transparency and stake holder involvement, allows just a resource allocation while maximizing the adoption of novel technologies, contributing to an outstanding national level of health despite relatively low health spending.

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How Managed Entry Agreements can improve allocation in the public health system: a mechanism design approach

Cited by 2 publications

References 19 publications

Factors Affecting the Patient Journey in Scheduling a Specialist Appointment in a Public Healthcare System

Factors Affecting the Patient Journey in Scheduling a Specialist Appointment in a Public Healthcare System

Priority setting for health technology adoption at the national level: Lessons learned over 25 years’ experience

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