Thomas Paine wrote in his presciently titled piece, The American Crisis, that ‘these are the times that try men’s souls’. Although chances are low that he had value frameworks in mind, Mr. Paine likely understood that, in a country that so cherishes liberty, equality may from time to ti me be sacrificed. Indeed, the country has historically opted to preserve choice among payers, rather than a government-run, single-payer healthcare system. Unfortunately, this liberty also includes the involuntary option to not have coverage at all, resulting in great inequity in the pursuit of a more perfect healthcare system. As the country’s legislative branch attempts to craft a replacement for former President Obama’s ACA, ISPOR became the crucible for debate around how a treatment option should be valued. While there is no clear conclusion at this juncture, ISPOR’s task force assessing value frameworks seems to be in the QALY camp – a bitter pill to swallow for most health plans that cannot even publicly admit to economic considerations (let alone net pricing) when disclosing their coverage decisions. While this year’s conference in Boston was decidedly focussed on the USA’s tumultuous environment, payers from more inclusive health systems like TWN revealed the results of their policies to encourage multinational investment through pricing premiums. Meanwhile, their neighbours in mainland CHN appear to be taking ever-increasingly bolder bounds forward in their effort to clean up the supply-chain and decrease overall patient cost-sharing burden. As CHN modernises, the USA stares down legislation that could lead to over 20m people losing healthcare coverage. At a time which cannot be described in many better ways than ‘crisis’, other countries push ahead through top-down policy to expand access to medicines and reward innovation.
With this year’s ISPOR International taking place in Boston, home to the origins of the American revolution, echoes of transformative uprising hundreds of years ago could easily be confused with the din of animated dissent over the path to value assessment in the USA. The week was dominated by diversely informed opinions on the future of value assessment in this land of many payers and a reluctant government. While the bounty may be a far cry from disloyalty to the Crown 240 years ago, make no mistake, these voices of discontent were once again fighting the pervasion of imperialism, this time in the form of King QALY.
At times, it was easy to forget that this was ISPOR International; the updates provided by a more serene cast of health authorities from around the world should have had a greater share of voice. The real-world results of policy from other, more efficient health systems, which generally took place in the early evening hours, included a few poignant lessons for their American counterparts. They are fixing different and, often, more advanced issues that, if undertaken by value framework advocates, could help to get the USA’s healthcare system back on track towards equality and liberty, two principles at the heart of local history and current debate.
To read CBPartners’ full summary and perspective piece on ISPOR International in Boston, drop an email to firstname.lastname@example.org.