In this same column a few weeks ago, I addressed public health spending on medicines and its impact on the sustainability of the National Health System (SNS). Another very important part of the cost is the cost of the health technology used in the diagnostic and treatment processes, an aspect that no one dares to put on the table, but which sits in the darkest part of the elephant room. It’s just there and nobody talks about it.
Current healthcare, which includes many elements and technological innovations, is a complex organizational and business network (knowledge-generating public administrations, universities, training and research centers, hospitals, scientific societies, professional groups, health technology companies, citizens and patients’ groups…) but it is always It should be guided by social priorities and equality, which does not always happen.
Who approves a new technology on SNS? The A network of autonomous health technology assessment agencies Benefits of National Health Service (RedETS). The objective is to evaluate in advance the safety of new diagnostic technologies for patients, their effectiveness (they meet the purpose for which they were designed) and their cost-effectiveness (their cost is offset by improvements in healthcare). Once its introduction is approved, each regional health service will decide when, how and where it is connected.
The revenue of the health technology market in SNS will reach 9.5 billion euros in 2022. Experts point out that this will be one of the main areas of increaseHealth costs, In the coming decades.
Inclusion of new technologies should be based on the added value of the health technology compared to other existing technologies and on health outcomes. Performance appraisal is related toDue to the limitation of SNS resources: When deciding to fund a particular intervention, the resources required for it cannot be used in other alternatives.
Investments in and use of diagnostic technology are not always balanced, and innovations are sometimes introduced that provide little value, benefit few patients and, in many cases, are correctly diagnosed with cheaper methods. In other cases, technological innovations have undoubted added value, covering unmet needs and making it possible to solve health problems that were previously difficult or impossible to diagnose. Decisions by healthcare managers about which investments to make in technology depend on a number of factors, including added value and the need for healthcare outcomes to outweigh industry, business and professional pressures.
In a public health system, decisions must be made about which services are funded and which are rejected, and the two are interrelated: if you have a limited budget, you cannot dedicate spending on one thing to another. You have to choose and how much to spend? How much should you invest in a technology that benefits the few and one that benefits the many? This is an easy question with a difficult answer and is solved in practice based on the interactions of the various actors involved in the process: politicians, managers, professionals and technical companies, depending on whether the pressure is high or low. Decisions are rarely made in each of them, but with a global view of this system.
We are used to talking about regional differences in health expenditure and the disparities this causes for health care in different autonomous communities; Much less is said about the internal disparities within each health area or hospital. It is clear to anyone familiar with how the public health system works that there are important dysfunctions in this regard, and that in the same hospital or healthcare area, there are other less developed areas with more developed technical areas. Even in health care, specialty and primary care, which often lacks basic technology, is much cheaper and benefits a larger number of patients.
Performance appraisal is related to From the moment we are aware of the limitation of our resources: when we decide to fund an intervention, the resources it requires cannot be used in other alternatives (health or other areas of well-being such as pensions, education or a focus on dependency). Others). Thus, as we move into the realm of collective decisions involving the use of public resources, the need is more than simply referring to purely individual decisions: it is not enough to make good decisions, but we must want the results to exist. Best possible.
It is certainly very difficult to find a balance between all the factors that determine investments in health technology, but there is no doubt that inequalities with respect to diagnostic possibilities based on the distribution of resources create first and second category diseases and patients. It is the duty of all involved in the process to rationalize and balance health technologies according to the importance of processes through prevalence and severity, health outcomes and health cost ceiling.
Miguel Baruco
Doctor and University Professor.