ali akbari sari, md, pgc, phd dean of school & associate professor school of public health
DESCRIPTION
Evidence Informed Policy Making Path to Iran Universal Health Coverage Lessons From Selected Evidence and Experiences. Ali Akbari Sari, MD, PGC, PhD Dean of School & Associate Professor School of Public Health Tehran University of Medical Sciences [email protected] - PowerPoint PPT PresentationTRANSCRIPT
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School of Public HealthTehran University of Medical Sciences
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UHC concept and dimensions Japanese new insurance coverage for H. pylori
eradication Management of Herceptin in breast cancer Mammography for breast cancer PET Scan for selected cancers MRI for low back pain CT Scan for head trauma CT coronary angiography for CAD Malaria control and elimination programs Diabetes and hypertension management Payment system Integrated evidence informed policy making Conclusion
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Japanese new insurance coverage for H. pylori eradication
The Japanese Society for Helicobacter Research published a guideline recommending that all H. pylori-infected people receive bacterial eradication therapy.
In response to this, the Japanese government has expanded coverage by the national health insurance scheme.
Int J Cancer. 2013 Mar 15;132(6):1272-6. doi: 10.1002/ijc.27965. A new approach for elimination of gastric cancer deaths in Japan. Asaka M.
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Not necessarily
Depends on the incidence of disease
Cost effectiveness ratio
Available resources
Other factors
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Before Policy: 80% of patients used Herceptine 20 % of costs could be covered by insurance
After Policy 20% of patients will use Herceptine 80% of costs could be covered by insurance
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7815
9262
11602
0
2000
4000
6000
8000
10000
12000
Billion Rials
2003 2004 2005
+18.5% +25.3%
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PET Scan is not suitable for screening or diagnosis
Appropriate for Staging /follow up of some cancers NSCLC Lymphoma Head and neck ….
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female primary site ASR male primary site ASR Total 1 breast 23.16 1 skin 19.15 14808.52 skin 13.16 2 stomach 14.9 98213 colon & rectum 7.4 3 bladde 11.3 65454 stomach 6.74 4 prostate 9.22 55865 esophagus 6.12 5 colon & rectum 8.02 49496 Hematologic 3.68 6 esophagus 5.71 3286.57 thyroid 3.47 7 Hematologic 5.36 3090.58 ovary 2.98 8 lung 4.63 2663.59 bladder 2.86 9 lymph node 3.67 2285.510 corpus uteri 2.45 10 larynx 2.98 1900.511 lymph node 2.26 11 brain & cns 2.46 165212 Lung 2.04 12 kidney 2.08 1442Total 58030
Cancer rate per 100000 in Iran
Then how many PET Scan do we need in Iran?
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Table 1:Number (%) of patients performed MRI according to their Indications and contraindications
Contraindication Total
- +Indication + 187
(46.7%)18
(4.5%)205
(51.2%)
- 186(46.5%)
9(2.3%)
195(48.8%)
Total 373(93.2%)
27(6.8%)
400(100%)
Paper in press : Sanaz zargar, Ali Akbari Sari1*, Reza Majdzadeh2 , Arash Rashidian1 ,Mohammad Arab1 and Hojjat Rahmani3
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37% of patients with MHT that underwent CT scan in emergency departments had no indication for CT scan.
86.5% of CT results were normal.
Iran J Prev Med, in press (May 2014) Sanaz zargar, Ali Akbari Sari1*, Reza Majdzadeh2 , Arash
Rashidian1 ,Mohammad Arab1 and Hojjat Rahmani3
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18
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19
Tre
atm
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t e
ffe
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fo
r h
yp
ert
en
siv
ein
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idu
als
(m
mH
g)
RuralUrban
Tre
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t e
ffe
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fo
r d
iab
eti
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(m
mo
l/L
)
RuralUrban
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500 to 1000 reported cases per year, no report of death Additional cost of about 100.000 US$ for one more case
prevented ITN more cost-effective
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Mammography for Breast Cancer
CT coronary angiography for CAD
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Ref. :Adapted from Busse R et al. Intern J Technol Assessment Health Care 2002; 18(2): 361-422
Evidence-based
Medicine
(EBM)
Clinical Practice
Guidelines(CPGs)
Health TechnologyAssessment
(HTA)
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Science Decision-Making
Evidence for Best Practices
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Use global evidence: KTE, … Provide mew evidence
Primary studies, SR, EE, … HTA KM (Clinical guidelines, protocols, …) Registry / surveillance system Payment system Control and monitoring Other programs: dual practice, family physician, …
Then provide financial resources dominantly via NHIS, NHS or a combination of them
This is perhaps the only Path to Iran UHC
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