1. Risk sharing or risk shifting? On the development of patient access schemes in the process of updating the national list of health services in Israel.
- Author
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Triki N, Ash N, Porath A, Birnbaum Y, Greenberg D, and Hammerman A
- Subjects
- Budgets, Drug Industry economics, Health Services economics, Humans, Israel, National Health Programs economics, Reimbursement Mechanisms economics, Risk Sharing, Financial economics, Uncertainty, Drug Industry organization & administration, Health Services Accessibility economics, National Health Programs organization & administration, Risk Sharing, Financial organization & administration
- Abstract
Background : Agreements between payers and pharmaceutical/medical device companies are widely implemented to address financial and clinical uncertainties. We analyzed the main characteristics of these agreements in Israel from 2011-2018. Research design and methods : We reviewed all agreements implemented during the study period. Information regarding the type of agreement, therapeutic indications, its time frame and the total budget involved are presented. Results : A total of 56 agreements were signed since 2011, of which 53 (95%) were financial-based and 50 (89%) referred to pharmaceuticals. The annual number of agreements increased from one in 2011 to 21 in 2018. The main therapeutic areas covered were: oncology (41%), hepatitis C (16%), neurology (11%), respiratory (9%), and cardiovascular (7%). The proportion of the annual budget allocated subject to these agreements increased accordingly from 3% in 2011 to 73% in 2018. The majority (63%) of the agreements were signed for 5 years, 9% were shorter-term and 20% have no time-limit. In 14 (44%) of the financial-based agreements implemented through 2017, the actual utilization exceeded the pre-specified threshold and the companies reimbursed the health-plans accordingly. Conclusions : The number of agreements and the allocated budget subject to these agreements increased substantially in recent years. Most agreements are financial-based that, in many cases, shifted the short-term financial risk from health-plans to the industry.
- Published
- 2019
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