Ruth
Your e-mail was forwarded to me for response. I head up the MEDICAL Advisory
Secretariat (MAS) in the Ontario Ministry of Health and Long-Term Care
(MOHLTC). My unit is the core of evidence-based analysis for MOHLTC and
works closely with a health sysytem stakeholder group (Ontario Health
Technology Advisory Secretariat (OHTAC) to prioritise, conduct
evidfence-based analyses through systematic review and economic analysis
which forms the basis for OHTAC discussion and recommendations to the Depity
Minister.
This formalised process can be found on the OHTAC website if you Google
“OHTAC”
We have established a continuity between evidence and policy decision making
and I recognize the concerns you raise with respect to implementation,
especially given the rapidity with which these technologies are presenting
themselves.
We have looked at a variety of ways to fund these technologies. The most
obvious is through the annual funding process. However, this does not allow
us to deal with in-year pressures.
We have prgressively moved towards joint responsibility between the health
system and MOHLTC in responding to these pressures. Hospitals have a global
allocation and are asked to factor in any down stream cost savings
identified in the economic analysis. This can include decreased bed
utilisation, obsolescence of older technologies, decreased follow-up etc
MOHLTC considers additional base funding for expensive new technologies but
aligns funding to adherence to guidelines set by the evidence-based analysis
such as drug eluting stents. For some technologies, such as bariatric
surgery, MOHLTC considers program funding based on an RFP process.
I believe there are additional ways to address this problem such as a health
technology fund that can be drawn down on for in-year pressures.
Whatever process is put in place, it is becomong clear to us that funding
new health technologies requires a close partnership and responsibility by
all players and that total costs and cost-savings must be factored in.
We have now done 73 evidence-based analyses which have moved forward to
policy development. We grapple with the same problem of funding
implementation and realize that this is only partiallu successful. We
continue to work on this.
If I can be of further assistance, please do not hesitate to contact me. It
might be easier to chat by phone. If you would like to do so, I can be
reached through my Executive Assistant, Jean Dalley at 416-314-1431.
Les
Leslie Levin MB, MD (Birm), FRCP (Lon), FRCPC
Head, Medical Advisory Secretariat, MOHLTC
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