This presentation was made by Vadim Perman, Israel, at the 6th Meeting of the Joint OECD DELSA-GOV Network on Fiscal Sustainability of Health Systems, held at the OECD Conference Centre, Paris, on 18-19 September 2017

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