Department of Health Systems Management, Faculty of Health Sciences and Guilford-Glazer Faculty of Business and Management, Ben-Gurion University of Negev, Beer-Sheva, Israel.
Value Health. 2012 Jul-Aug;15(5):737-42. doi: 10.1016/j.jval.2012.01.007. Epub 2012 Apr 11.
Risk-sharing is being considered by many health care systems to address the financial risk associated with the adoption of new technologies. We explored major stakeholders' views toward the potential implementation of a financial risk-sharing mechanism regarding budget-impact estimates for adding new technologies to the Israeli National List of Health Services. According to our proposed scheme, health plans will be partially compensated by technology sponsors if the actual use of a technology is substantially higher than what was projected and health plans will refund the government for budgets that were not fully utilized.
By using a semi-structured protocol, we interviewed major stakeholders involved in the process of updating the National List of Health Services (N = 31). We inquired into participants' views toward our proposed risk-sharing mechanism, whether the proposed scheme would achieve its purpose, its feasibility of implementation, and their opinion on the other stakeholders' incentives.
Participants' considerations were classified into four main areas: financial, administrative/managerial, impact on patients' health, and influence on public image. Most participants agreed that the conceptual risk-sharing scheme will improve the accuracy of early budget estimates and were in favor of the proposed scheme, although Ministry of Finance officials tended to object to it.
The successful implementation of risk-sharing schemes depends mainly on their perception as a win-win situation by all stakeholders. The perception exposed by our participants that risk-sharing can be a tool for improving the accuracy of early budget-impact estimates and the challenges pointed by them are relevant to other health care systems also and should be considered when implementing similar schemes.
许多医疗保健系统正在考虑风险分担，以解决采用新技术所带来的财务风险。我们探讨了主要利益相关者对潜在实施财务风险分担机制的看法，该机制涉及对以色列国家卫生服务清单中新技术的预算影响估计。根据我们提出的方案，如果一种技术的实际使用量大大高于预期，健康计划将部分得到技术赞助商的补偿，而如果健康计划未充分利用预算，则将向政府退还资金。
通过使用半结构化方案，我们采访了参与更新国家卫生服务清单（N = 31）过程的主要利益相关者。我们询问了参与者对我们提出的风险分担机制的看法、该方案是否能够实现其目的、实施的可行性以及他们对其他利益相关者激励措施的看法。
参与者的考虑因素分为四个主要领域：财务、行政/管理、对患者健康的影响以及对公共形象的影响。大多数参与者认为，概念性的风险分担方案将提高早期预算估计的准确性，并赞成该方案，尽管财政部官员倾向于反对。
风险分担方案的成功实施主要取决于所有利益相关者将其视为双赢局面的看法。我们的参与者所暴露的风险分担可以是提高早期预算影响估计准确性的工具的观点，以及他们所指出的挑战，与其他医疗保健系统也相关，在实施类似方案时应予以考虑。
