Esensi dan Positioning Evaluasi

Ekonomi, HTA, dlm Sistem Jaminan

Budi Hidayat
CHEPS FKM Universitas Indonesia
June 5th, 2023

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Things to Share

1. Sistem Jaminan dan trend perubahan decision-making;

2. Konsep Evaluasi Ekonomi (why, how, and outputs);
3. Profiling Aplikasi HTA Terkini dan usulan HTA-Ind Model
kedepan (Roadmap).

BHidayat - CHEPS FKM UI 2

Apakah “X= Obat,Alkes, Procedures, Treat, etc” dijamin dalam sistem jaminan?
[Dilematis kemajuan ilmu, nilai uang & etika: due to asymmetric info]
PAYER/Govt
“Give us more
evidence that BPJS
your “X” is
value for
money”: call for
HTA

“But we will not be

able to provide the
real-life data you
require prior to
reimbursement”

INDUSTRY/
Supplier
3
.. and the Decision Power Is now Changing!
Sistem Jaminan memberikan peluang semua stakeholders terlibat dalam
pengambilan keputusan tentang praktik layanan kesehatan

Klinisi
Mgt RS J
K
Payer N
Govt
Pasien
Dulu Sekarang Kedepan
4
Why do we need “EvalEkon: FarmakoEkon, HTA, dll”?
Total expenditure on health 1960-90 (% GDP) OECD

• Tahun1980-an (historis), terjadi 12 11,9

lonjakan biaya kesehatan 11

(diantaranya) karena:
10

9 9
8,7
8,5 Canada

Percentage
– Kemajuan teknologi
8 Sw itzerland
7,6
7 7 7,1 United Kingdom
6,9
United States

– Kompleksitas sistem kesehatan

6 6
5,6 5,6
5,4
5 5,1
4,9
4,5
4 3,9

3
1960 1970 1980 1990
Years

FAKTA: Penyebab utama lonjakan biaya adalah kemajuan

TEKNOLOGI KESEHATAN
Perlu symmetric info utk
• “Most, if not all, [macro] economists and policy analysts agree that
technological advance is a key driver of health expenditure growth”
memilih “alternatif teknologi”
[AARON, M, Health affairs, 2002] dlm pengobatan pasien  HTA
• The role of new technologies in the health care expenditure growth is
estimated at 50-70% (Itinera, 2010) 6
Esensi EvalEkon (HTA): Bridging “science” & “decision
making”

HTA

Technology Assessment
Pengambilan
ILMU Keputusan

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Untuk siapa dan apa outputs EvalEkon?
Target pengambil keputusan yang dibidik HTA adalah..
Micro (Praktik
Professional)
- Petunjuk praktik
layanan kesehatan
bagi Faskes
Macro (Kebijakan
- Quality Assessment Kesehatan)
& Assurance Meso (Manajemen
Institusi) - Perencanaan
- Monitoring (termasuk setting
utilisasi – URM manfaat)
- Rambu-rambu - Regulasi
konflik payer vs
providers 8
Kontinum EvalEkon: Praktik HTA Global
Praktik di Indonesia

Technology Development Technology Adoption Use of Technology

++Approval Stage++ ++Patient Access Stage++ ++Impact Stage++
Health & Economic
outcomes
3rd HTA Hurdle Assessment (BPOM)
4th HTA Hurdle Assessment (FORNAS Team)

5th HTA Hurdles Assessment (KPTK Team)

Praktik HTA kondisi sekarang di Indonesia
Usulan Praktik HTA Kedepan
Technology Development Technology Adoption
++Approval Stage++ ++Patient Access Stage++ It takes time, somehow
overlap & complex
process, also redundancy
Do up to 3rd HTA Hurdles by BPOM that involve many actors
with diff interests.
Do up to 4th HTA Hurdles by Fornas Tim
Do up to 5th HTA Hurdles by KPTK
Goals: to create a better ecosystem of the potential for use of HTA in any decision level, streamlining HTA practices
& gaining efficiency in applied HTA
Technology Development Technology Adoption Use of Technology
++Approval Stage++ ++Patient Access Stage++ ++Impact Stage++

MH & Economic State

Used for Licensing by BPOM

Used to evaluate health
Used to create NEM &/ FORNAS by Fornas Tim outcome, including ROI,
Used to refined FORNAS for reimbursement decision macro and econ growth

Strategy (how): all continuum (1st to 6th hurdles) HTA are done by Independent HTA-body (e.g., KPTKI & its agency).10
Findings are FWD to stakeholders for their policy decisions
Arah Roadmap HTA-Ind: Kelembagaan (long term)

Kelembagaan HTA :
 STRONG Independent Body (free from all conflicts of interest) untuk
inputs policy ttg: pengembangan, perizinan, diseminasi dan penggunaan
teknologi, dan mendorong efektifitas pelaksanaan rekomendasi policy tsb.
 Fungsi: jembatan empirical riset dan proses pengambilan keputusan
teknologi.
 Posisi: Pembatas antara riset dan formulasi kebijakan utk fulfillment
demand thd info comprehensive, symmetric/balance, transparan dan
valid, serta menjamin partisipasi masyarakat /publik.

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Arah Roadmap HTA-Ind:
Streamlining Business Process HTA
HTA Topic  Open Proposal
Selections  Enabler: guidance on topic
selection

 Dynamic assessment
HTA Assessment  Enabler: Revised guidance on
each HTA Assessment & Appraisal

HTA Appraisal
Review HTA Adaptive HTA Full HTA
(r-HTA) (a-HTA)

Trd HTA RWD/E HTA

CHEPS UI, MOH and WHO 12

Arah Roadmap HTA-Ind: Teknologi dan Kriteria
[Existing (2023) & Proposal]

• Obat-obatan,
• Safety, Efficacy & Quality
• Skrining
• Diagnostik & Vaksinasi, • Cost Effectiveness (e.g. CEA,
• Prosedur medis & bedah, Penilaian CUA), or economic
• Peralatan medis, Teknologi • Affordability (e.g., BIA)
• Alat bantu, Kesehatan • Organizational Impact
• Pelayanan medis, • Ekuitas & Etikal
• Program kesehatan (PTK, or HTA)
• Feasibility
• Acceptability to provider
Technologies • Acceptability to patient
Teknologi mencakup keseluruhan teknologi yang dijamin atau
dipertimbangkan utk masuk penjaminan dalam sistem jaminan (e.g., Assessments Criteria
JKN) serta program kes lainnya (promotif).
CHEPS UI, MOH and WHO 13
 Arah Roadmap HTA-Ind Model:
Identified Strategic Areas & Determinant
Strong & Independent HTA
Body
Standardized and Rigor Econ
Eval in all HTA hurdles
Adequate Finance & Human
Resources , inc agent, Univ, etc
Adequate ecosystems and
infrastructure for executing
HTA
Simple, reasonable & transparent business
process
4 area strategic future HTA works :
1. Addressing HTA needs for curative
2. Addressing HTA needs for public health
3. Facilitating better access to public and
curative health technologies
4. Optimizing the safe and use of rational
health technology
…. and many other determinant not listed
here
CHEPS UI, MOH and WHO 14
Main-Beef of the HTA-Ind Roadmap

4 Strategic Areas 5 Element Approach

1. HTA needs for curative 1. Human Resources Development
2. Integration of HTA into Public Policies
2. HTA needs for public health 3. Institutionalized strong HTA body
3. Facilitate better access to technology 4. Promote Production of Evidence and
4. Safe & rational use technology Dissemination
5. Promote Network Collaboration

Both strategic areas and approaches

are translated into 12 Items Action
Plan,Time Table & Budget
CHEPS UI, MOH and WHO 15
 • Semua yang baik datang dari Allah SWT.
• Mohon ma’af jika ada hal-hal yang salah, dan/atau kurang berkenan.

Terima Kasih dan Semoga Bermanfaat

BHidayat - CHEPS FKM UI 16