The Value Of Health Care – A Matter Of Discussion In Germany

The Value of Health Care – A Matter of Discussion in Germany.
Franz Porzsolt1,3 Moritz Ackermann1 and Volker Amelung2,3
1Clinical Economics, University of Ulm, Germany
2 Department of Epidemiology, Social Medicine and Health Systems Research, Hannover Medical University, Germany
3 Federal Association of Managed Care, Berlin, Germany


Abstract

Background: Interest in assessing thevalue of health-care services in Germany has considerably increased since the foundation of the Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, IQWiG [Institute for Quality and Efficiency in Health Care]. The practical application of value assessment illustrates how problematic the process can be and shows how necessary it is to discuss procedures for the assessment of value inpublic. In all decisions made for the provision of health care, data concerning the measurable dimensions (quantity and quality of efficacy and effectiveness, validity of the results, and costs) flow into complex and not yet standardized decision-making processes concerning public financing. Some of these decisions are based on data of uncertain validity, unknown reproducibility and unclearappropriateness of the decision-making processes. Methods: In this paper we describe the theoretical aspects of value from psychological and economical viewpoints as well as international and national approaches. Methodological details and problem to assess the value of health care services are analyzed. Results: A definition of the intangible value of health-care services will be proposed which containsonly three factors – the absolute risk reduction (usually a measure of efficacy), the validity of the scientific papers examined, and the type of expected effectiveness (prevention of death, disability, or restitution of well-being). Therefore, the intangible value always describes the additional benefit when comparing two possible actions (e.g. treatment of observation only). Conclusion: Thedescription and assessment of intangible value from the viewpoint of different stakeholders is a prerequisite for the following step (which will not be discussed here) – the evaluation of costs and of benefit or ad-vantage. A standardized evaluation is needed for the definition of a basic benefit package. The process of decision making guarantees transparency, it is fair and democratic.Background

The foundation of the Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, IQWiG [Institute for Quality and Efficiency in Health Care] exemplified the need for a scientific and independent evaluation of health-care services in Germany. Since a basic benefit package should be publicly financed, the assessment of its value cannot rely merely on supply and demand. The problemarises due to the different points of view concerning what is adequate, appropriate, and economic. The definition of this range of services is a political decision which should be supported to the greatest possible extent by scientific data.
For this purpose institutions have been established in different European states and in Australia and Canada to carry out a scientific evaluation of theavailable data [as-sessment] and then to perform a political interpretation and make decisions [apprais-al]. In most countries, these two steps, assessment and appraisal, are performed by separate and independent institutions. The pioneering function of Anglo-Saxon countries is plausible because the necessity of making transparent decisions in their health care systems - which are financed by the nationaltreasury - is consid-erably greater than in systems which are based on private and social insurances.

In most industrialized countries, health care is one of the most important market segments and, therefore, has considerable importance for the overall economy. Ap-propriate growth of this market and a high potential for innovation can be considered positive indicators for the welfare of a...