It is a fact that the incorporation of technologies in public and private systems around the world has promoted improvements in healthcare services and in the quality of life of patients. However, it is also known that these new technologies bring an increase in costs for the sector.

This happens in a scenario in which life expectancy and, as a result, the aging of the population, also grows year by year, making the increase in healthcare costs a challenge to be overcome.

To better assess and plan the incorporation of technologies in the sector, there are Healthcare Technology Assessments (HTA), a multidisciplinary process that takes into account information on medical, social, economic and ethical issues to support decisions on the use of these technologies.

HTA began to be developed in the technology department of the US government in 1976 and began to be disseminated to other countries in the 1980s. Today, the methodology is also used by countries such as Canada, England, Australia and Argentina.

In Brazil, HTA is a mandatory step for the incorporation of technologies in the Unified Health System (SUS). As they are responsible for serving almost a quarter of the country’s population, private plan operators play an important role and, therefore, the increase in costs in this area should be studied and debated.

In this Article, we will talk about the reasons for the increasing cost of supplementary healthcare and the importance of HTAs to overcome this challenge.

How to assess cost-effectiveness in the incorporation of healthcare technologies

One of the steps of HTA is the cost-effectiveness assessment. The objective of this phase of the study is to compare different technologies to assess which one is capable of providing greater effectiveness for a given cost, or a given healthcare outcome for the lowest cost. To this end, costs are evaluated in monetary values, while effectiveness is measured based on parameters such as mortality, morbidity, hospitalization, etc.

Studies by theInstitute for Supplementary Healthcare Studies (IESS) indicate that healthcare products and medicines have been the main causes of the increase in supplementary healthcare costs in recent years.

What raises costs in supplementary healthcare?

The supplementary healthcare system involves several actors, such as healthcare plan operators, service providers and suppliers of medicines, materials and equipment. In the case of such a complex network, it is natural that one wonders where the increase in costs comes from, which is reflected in higher prices of health plans for the beneficiary.

To answer this question, operators point out that there would be excesses in two links of the chain:

• Beneficiaries would use medical services much more than is actually necessary;
• Doctors and hospitals would exaggerate in requesting procedures and exams, since they are paid for this.

In this way, the system would encourage waste and even fraud, since some actors in the system would be encouraged to prescribe medication and request unnecessary procedures.

The increase seen in the expenses of health plans, however, happens more quickly than that of hospitals and medicines, which indicates that the issues raised by the operators, therefore, do not explain the problem in its entirety. Another point that can be raised is the efficiency of management, especially in two aspects:

• In general, healthcare plans do not offer beneficiaries the necessary guidance and mechanisms that aim to promote the adequate and rational use of resources. Instead, to reduce costs, operators restrict beneficiary access, creating barriers that generate dissatisfaction with the system;
• Operators usually use the cost of procedures as the main element of negotiation with the accredited network, which leads this link in the chain to lower the quality of services. In the long run, this situation generates more waste and less effectiveness.

The role of HTA in the reduction of supplementary healthcare costs

In addition to being essential for the evolution of the healthcare sector and for increasing longevity and improving the quality of life of the population, technologies are important to bring efficiency to care, agility and accuracy in diagnoses, and may even reduce costs of procedures.

The HTAs, based on scientific evidence and cost-effectiveness analyses, provide greater rationality in decision-making on the incorporation of technologies, thus being able to contribute to the optimization of resources in the supplementary health system as well.

To learn more about HTA and cost-effectiveness analysis of the incorporation of healthcare technologies, download the MAPES e-book : Cases & Solutions..