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This report discusses the need for an integrated and cyclical approach to managing health technology in order to mitigate clinical and financial risks, and ensure acceptable value for money. The analysis considers how health systems and policy makers should adapt in terms of development, assessment and uptake of health technologies. The first chapter provides an examination of adoption and impact of medical technology in the past and how health systems are preparing for continuation of such trends in the future. Subsequent chapters examine the need to balance innovation, value, and access for pharmaceuticals and medical devices, respectively, followed by a consideration of their combined promise in the area of precision medicine. The final chapter examines how health systems can make better use of health data and digital technologies. The report focuses on opportunities linked to new and emerging technologies as well as current challenges faced by policy makers, and suggests a new governance framework to address these challenges.

New technologies are entering health care systems at an unprecedented pace: remote sensors, robotics, genomics, stem cells, and artificial intelligence are on the cusp of becoming a normal part of medical care. Medicines can now be combined with nanotechnologies and digital tools. 3D printing is already used to manufacture implants, and bioprinting is expected soon to modify organ transplantation. Precision medicine, which establishes links between individuals’ biology and their diseases, promises to increase our understanding of diseases and help better target treatments. Vast amounts of electronic data related to health and wellness are being generated by health systems and by individuals. Collectively, these data hold valuable information that could foster improvement in all health system activities, from clinical care to population health, to research and development.

Pharmaceutical markets are changing across the world, raising a number of new questions that need to be addressed. This chapter first examines trends in R&D and in market approvals, highlighting gaps in R&D investments and the focus of new treatments on small population targets. Then, it looks at current challenges faced by policy makers, from pressure to speed market access to worrying trends towards the proliferation of high-cost products, which do not always deliver value. Finally, it reviews policy responses to these challenges and possible options to go further.

Technology has been a dominant force in health and medicine, contributing to longer and healthier lives for many people. An early milestone is the aseptic technique, devised in the 19th century, which dramatically reduced avoidable deaths. Antibiotics and vaccines remain, to this day, among the most successful health technologies. Since then, medicine has been strongly associated with technological progress, as a visit to any modern clinic, pharmacy or hospital confirms. Some technologies – insulin, for example, or treatment for heart attacks and stroke – have been remarkably valuable. Others, however, have delivered fewer gains.

Medical devices cover a wide range of products of varying complexity and clinical risk. Practitioners’ aptitude in using medical devices in clinical settings also varies. Regulation, coverage and funding of devices thus present a considerable challenge for policy makers who need to balance the often competing objectives of safety, effectiveness, equity and timely access. Regulatory requirements for medical devices were historically less stringent than those for pharmaceutical products. This chapter examines the current state of play for medical device regulation (determining the safety, performance and effectiveness for initial market authorisation and post-market evaluation) and coverage and funding (determining their inclusion in payment schedules and the reimbursement level for their use). It provides a series of recommendations to improve these aspects of regulatory regimes in OECD countries and other health care systems. The chapter also describes the institutional requirements and policy framework needed to enable sound regulatory, coverage and funding decisions. These include governance, information infrastructure and stakeholder involvement.

Modern health care systems produce mountains of electronic data, which are now also generated outside health care systems as most aspects of human activity and interaction become digitalised in the modern global economy. The information potentially residing in these data can be very useful to promote health, and to improve health care – a particularly information- and knowledge-intensive industry. This chapter describes various opportunities for harnessing health data, citing examples where the potential is being realised. It discusses the challenges of using health data and sets out a policy framework for managing risks while realising the benefits of health data. The costs of implementing digital technology across societies and health care systems are discussed. This is followed by a more in-depth discussion of the electronic health record (EHR), an important foundation of health information infrastructure. Drawing on the findings from a 2016 study of EHR development and use in 30 OECD countries, health care systems’ readiness to use EHR data collected for various purposes – performance monitoring, quality improvement and research – is examined.

The proliferation of health technology over the past century has profoundly influenced service delivery and health outcomes. It has also been a dominant factor in the growth of health care expenditure observed in the majority of OECD countries over this time. Has the expenditure growth been “worth it” in terms of health benefits? Could more value have been generated by allocating resources in alternative ways? These questions are ever more important given the modern context of fiscal limitations, demographic changes and rising community expectations. This chapter examines the historical impact of health technology and applies these learnings to the future management and integration of emerging technologies such as precision medicine, combination products, mobile health and 3D bioprinting. It discusses the need for and utility of efforts such as horizon scanning and foresight studies to help health care systems prepare for the types of health technology that are still some way off but have the potential to both disrupt and revolutionise health care delivery.

Precision medicine (PM) refines our understanding of disease prediction and risk, onset and progression in patients, informing better selection and development of evidence-based targeted therapies and associated diagnostics, by taking into account the patient’s genomic and other biological characteristics, as well as health status, medications patients are already prescribed and environmental and lifestyle factors.This chapter first describes the topic of PM, discussing its current application and challenges. These include establishment of economic incentives to develop biomarker testing and regulatory challenges such as market approval of companion diagnostics and treatments, Health Technology Assessment and coverage and funding decisions. Emerging trends in PM are then discussed, including next-generation sequencing (NGS) testing, patient-centric clinical trials, and sharing of data and knowledge.

This chapter presents an overview of the analytical report prepared by the OECD Secretariat for the 2017 Health Ministerial on “New Health Technologies: Managing Access, Value and Sustainability”. The report discusses the need for an integrated and cyclical approach to managing health technology to mitigate clinical and financial risks and to ensure acceptable value for money. This synthesis chapter considers how health care systems and policy makers should adapt in terms of the development, assessment and uptake of health technologies. Following a brief examination of the past adoption and impact of medical technology, this synthesis chapter focuses on opportunities linked to new and emerging technologies as well as current challenges faced by policy makers. It concludes with a suggested new governance framework to address these challenges.