The document outlines the National List of Health Services (NLHS) in Israel, encompassing over 3000 pharmaceuticals and approximately 1,100 other technologies, with a total cost of NIS 48 billion. It details the assessment and integration processes for updating the NLHS, including economic evaluations and public committee deliberations on technology inclusion. Key challenges addressed include rising technology costs, definition dilemmas for life-saving technologies, and budget allocation decisions.

1. HEALTH BASKET UPDATE
PROCESS – PERSPECTIVES
FROM ISRAEL
MR VADIM PERMAN
MINISTRY OF HEALTH

2. What is the scope of the National List of
Health Services (NLHS) ?
The NLHS includes:
- over 3000 pharmaceuticals
- approx. 1,100 other technologies
The Cost of NLHS –
NIS 48 billion
Israeli Pharmaceutical market -
approx 8-9 billion (NIS)

3. Technologic addition to the health basket (millions
of NIS)

4. Technologic addition to the health basket out of total
health basket
Source: Ministry of Health data; Pharma Israel analysis. Data in graph is based on the Basket Committee available data, and excludes additional
24m NIS in 2015 (total 2015 - 324m NIS), additional 15m NIS in 2009 (total 2009 – 416m NIS), additional 60m NIS due to third addition to the
health basket (total 2008 - 510m NIS). Data also excludes budget allocated to dental care for children and elderly.

5. The scarcity problem: technologies rated A8-A9 and A9 vs.
budget for addition to the Health Basket
Source: Pharma Israel analysis

6. Economic
Evaluation
Pricing, CUA,
CEA
Epidemiological
Evaluation
Needs Assessment
& target
population
Social
Ethical
Political
Legal
Comprehensive
evaluation
National Policy
in healthcare
technology
Legislation
Clinical
Evaluation
Medical assessment
safety, efficacy
Updating the National Health Basket
Aspects

7. UPDATING THE NLHS - STEPS
submissions of applications to the MTIA
March
January
March-July
July-October
October-December
• Safety, efficiency,
literature review
• benefit, epidemiologic
assessment
• Sub-committee
• National Councils
• Medical organizations
Director-General’s Directive on
submission of technologies for the NLHS
Technology assessment of said
submissions
integration of information
National Public Committee

8. Public committee – decision making
18 members:
Chairperson
the director of the MTIA
4 Physicians
4 Economists
4 Health Funds
4 Public representatives from
the fields of medical sciences, ethics, social sciences and
welfare.

9. COMPREHENSIVE ASSESSMENT
Comparison
to alternative
treatment
options
evidence-based
medicine - efficacy
Economic
evaluation
Identification
of specific
patient groups
Incidence,
Prevalence,
Morbidity &
Mortality
SafetyRegulatory
status in Israel
and abroad
Relevant
clinical
guidelines
Public
funding

10. 10
KEY ELEMENTS IN TECHNOLOGY
INCLUSION
Budget Impact
Professional
associations
recommendation

11. DILEMMAS FROM THE PUBLIC
COMMITTEE
MUCH FOR A FEW LESS FOR MANY.
WHAT IS THE DEFINITION OF A “LIFE SAVING TECHNOLOGY”?
URGENT HEALTH NEEDS VS. INVESTMENT IN FUTURE HEALTH (PREVENTION).
WHAT SHOULD BE THE STANDPOINT OF THE COMMITTEE (HEALTH SECTOR VS.
OVERALL NATIONAL CONSIDERATIONS) ?
INCLUSION IN THE NLHS FOR A LIMITED PERIOD OF TIME.
SHOULD THE COMMITTEE LIMIT RECOMMENDATIONS TO THE BUDGET
ALLOCATED OR HIGHLIGHT HEALTH NEEDS ?

12. RISING COST OF TECHNOLOGIES – WHAT CAN
BE DONE ?
• PRICE NEGOTIATIONS
• DEFINING SPECIFIC PATIENT GROUPS WHO BENEFIT THE
MOST FROM SAID TECHNOLOGY
• LIMITATIONS – LINE OF THERAPY, CLINICAL
CHARACTERISTICS
• CLASS EFFECT
• PERFORMANCE BASED RISK SHARING SCHEMES
• CAPPING AGREEMENTS

13. In conclusion:
 Israel has created a uniform nomenclature, definitions and
methodology for HTA under governmental leadership.
 The mechanism is both feasible and practical for the needs of the
Israeli healthcare system and involves all stakeholders.
There is a direct link between HTA, Decision making and Budget
allocation.
The process is highly accepted by the health system, judicial
system, political system and the general public.

14. Thank you for your attention