School of Public HealthTehran University of Medical Sciences

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

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.

Not necessarily

Depends on the incidence of disease

Cost effectiveness ratio

Available resources

Other factors  

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

7815

9262

11602

0

2000

4000

6000

8000

10000

12000

Billion Rials

2003 2004 2005

+18.5% +25.3%

PET Scan is not suitable for screening or diagnosis

Appropriate for Staging /follow up of some cancers NSCLC Lymphoma Head and neck ….

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?

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

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

  

18

19

Tre

atm

en

t e

ffe

cts

fo

r h

yp

ert

en

siv

ein

div

idu

als

(m

mH

g)

RuralUrban

Tre

atm

en

t e

ffe

cts

fo

r d

iab

eti

cs

(m

mo

l/L

)

RuralUrban

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

Mammography for Breast Cancer

CT coronary angiography for CAD

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)

Science Decision-Making

Evidence for Best Practices

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