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The Foundation’s research in health covers a broad and varied array of areas. Its studies include current pressing topics in public health; health economics; health policy; clinical management and health technology assessment. The Foundation’s philosophy is to widely share health findings, so its publications, books and studies are readily accessible to the general public, downloadable for free on the internet.

Some of GCF’s key research and studies from the past five years include the following:



Real World Data in the Spanish health care system

This book, on the cutting-edge topic of Real World Data, very clearly expounds on the methodology behind these data, practical applications of their use in decision making, and specific examples and results from clinical practice in Spain. With collaboration from Lilly, this study provides a comprehensive view of the tremendous potential for Real World Data to help improve health and its value and place in health and medicine in conjunction with randomized controlled trials.

Executive Summary
Medicines and social wellbeing: including productivity costs in economic evaluations

There is an unresolved debate by healthcare policy experts and decision-makers as to whether or not to include "productivity" and its effects ­ also known as indirect costs - in economic analyses. This important book, with funding from Novartis, sheds light on this critical topic by looking at it from both a theoretical and practical standpoint. It includes a comprehensive review of the literature regarding the costs of productivity in economic evaluation and provides expert opinions by reputable, renowned researchers in the field. The volume´s contribution is a clear picture of the issue from a social wellbeing perspective. It also shows how in spite of having a standardized process for conducting healthcare technology assessment in Spain, there is no accepted methodology for determining priorities or ways to incorporate unit costs and Quality Adjusted Life Years (QALY) that include the priorities and preferences of patients. It is suggested that including patient reported outcomes in analyses could help correct for this shortcoming.

eHealth: Applications and Tendencies

Technology is transforming our world as we know it, and this includes healthcare. We currently have better information, knowledge, connections and evidence - and better opportunities for using them - than ever before. In collaboration with Almirall, this timely volume covers many different perspectives and angles regarding eHealth and telemedicine. It describes such important topics as the concept of the web; how it has evolved; the usefulness of the huge amounts of available health information; applications of ICT, HTA, social platforms, blogs and webpages; the benefits of such developments as online radiology reports; the importance of disseminating innovation; and ideas for taking advantage of the enormous potential that exists thanks to the internet. The book also explains some of the pitfalls and limitations of this new reality and how more is not always better.

Health Services Research for Political Action

This book, supported by Merck, underlines the importance of health services research to anticipate change and thus, improve health. It first critically assesses the Spanish healthcare system, highlighting strengths and opportunities, but also weaknesses and risks. A second part consists of an analysis of discussion group findings by top experts in the field. Finally, based on these insights, conclusions and recommendations are made with a road map to guide health care decision makers. Most importantly, the book stresses the importance of 1) evaluation in every aspect and at every stage of the healthcare process; 2) political professionalism; and 3) trust among the different agents. The volume ends with 6 very clear recommendations for better utilizing health services research to bring about improvement in health.

Innovation and Solvency: a double-edged sword for the sustainability of the Spanish healthcare system

This book examines the current tensions in the healthcare system between solvency and innovation, and proposes such alternatives as co-payments through income tax charges for demonstrated inadequate emergency room use. With a backdrop of budget shortages and the financial crisis, the Spanish healthcare system, like health systems all over the world, is grappling between the push for constant advances with their inherent high costs and the system´s three main pillars of public financing, universal coverage and equity of access. With support from Celgene, this book provides insight on these challenges and proposes innovative alternatives that could be relevant for healthcare systems around the world.

Workbooks of Health Management

Three different issues of Workbooks of Health Management include discussions on such pressing topics as Innovation in the management of health organizations, Innovation and medicines, and Ethics in health decision making. In collaboration with Almirall, a summary of these issues is as follows:

The first issue provides insight on efficient and sustainable health management, which entails organizational innovation. This requires training in human resources for intelligent management of innovation as well as to understand new public financing mechanisms. Different organizational models are also presented.

The second issue reflects upon positive and negative aspects of innovation in the pharmaceutical sector. This includes the specifics of health decision making at each level of management (macro, meso y micro).

The third issue discusses the topic of ethics in decision making. This is considered from all levels: from a doctor´s point of view for his or her patient; from the perspective of the health organization; and also from the health policy level. This issue covers the cognitive, procedural and bioethical criteria upon which decisions are made.


Spanish health in numbers 2014

This book critically analyzes the delivery of health services in the different regions of Spain. This is particularly important because it sheds light on the degree to which the economic crisis has affected health care delivery in the decentralized Spanish healthcare system. Using 50 key indicators, this study, which was published by the Círculo de Sanidad, serves as a reference point for planning and decision making by the different Autonomous Communities of Spain.

Policy and evaluation of hospital medicines

This study carries out the latest review of such critical issues as pharmaceutical risk sharing agreements, treatment adherence, and the economic impact of different pricing agreements. The book, published in collaboration with TEVA, demonstrates and underlines the usefulness and importance of economic evaluation for the pricing of medicines. Using focus groups, four qualitative analyses were carried out on the following topics:

  • Reports on Therapeutic Positioning, including development, methodology and implementation;
  • Innovative Agreements or Shared Risk Agreements;
  • Treatment Adherence, Chronic Diseases and Health Results. The factors influencing non-adherence are studied, as well as possible interventions to reduce non-adherence, with the aim of bringing about better healthcare and quality of care;
  • Economic evaluations. Key aspects were analyzed for their incorporation into the healthcare decision making process.

Indirect cost analysis: the case of cancer

This book focuses on the indirect costs of cancer. Published by the GCF in collaboration with AMGEN, it includes a conceptual framework, a literature review, an analysis of focus group discussions and conclusions and recommendations. More than ever, experts are insisting on the importance of understanding the real implications of cancer and other diseases on society. This means considering indirect costs in economic evaluations, as is the case in Holland and the UK. As GCF Director Juan del Llano states "Studying and analyzing diseases from the correct perspective is demanded by citizens and society."



Clinical Management: the Way Forward

Clinical management is the bridge between clinical practice and business management. Above all, it is about coordination and leadership. Clinical management´s overall aim is to improve patients´ health either individually or as a group. This publication, funded by the GCF and published by Piramide, focuses on the key areas necessary to implement and develop clinical management. It is organized in three parts: 1) Health Policy, covering the State´s responsibility regarding equity and overall oversight; 2) Management of health services, focusing on the management of primary centers and hospitals; 3) Management of clinical practice, concentrating on the more micro area of clinical activity.

Health Technology Assessment and Health Policy Today: a Multifaceted view of their unstable crossroads (Original in English)

This book, published by Springer, presents a critical view of health technology assessment. It analyzes the interface between the advancement of HTA and health policy. It highlights the factors that should shape the progress of HTA in the near future. Multifaceted, interdisciplinary views from a number of international experts are presented in order to analyze and make recommendations regarding next steps for HTA.

Real World Data (RWD) - Its contribution to improvements in clinical practice and patient resource use

Due to shrinking budgets and the economic crisis, there is more pressure than ever to make the most of limited resources. At the same time, thanks to the internet and growing capabilities for managing huge amounts of data from clinical practice (data-mining), there has been a rise in the number of studies based on data from clinical practice. These observational studies based on real data from clinical practice (RWD) cannot substitute randomized clinical trials, but they can help complement them by incorporating critical information from large numbers of patients in real clinical settings. In fact, RWD is deemed key to inform us of the benefits and risks of different interventions in patients with multiple and complicated health conditions. This book, in collaboration with Lilly, discusses this timely, relevant and important topic in depth.

Reinvestment: pending work of the national health system

At a time of budget constraints and pressures on the healthcare system, reinvestment - the switching from financing medicines, medical supplies, appliances or procedures with low clinical value to those with high value and return - is of increasing importance. This study, supported by Roche, tackles the challenges facing reinvestment and its relevance in Spain.



Translational research: learning to listen

Translational research "translates" findings from research into medical practice, aiming to bring about improved outcomes. This study, in collaboration with AbbVie, compiles research and information from over 150 publications and references with the aim of providing an updated overall understanding of translational research. In addition, through a qualitative approach, it provides a clear and operational vision for the future.

Guarantees, solvency and sustainability of the Spanish National Health System: qualitative analysis from the hospital pharmacy

This book, in collaboration with UCB, sheds light on perhaps the most important issue facing health care systems around the world: their sustainability. In other words, how can health systems offer top services and medicines in a lasting way? In light of budget constraints, the following themes are covered: the need for clearer rules regarding the financing of medicines; demonstrated cost-effectiveness for public financing of innovative therapies; collaborative efforts to evaluate health technologies; and more transparent regulation based on value for all new therapeutic innovations.

Healthcare technology assessment in five European countries: learning from one another

This critical study analyses healthcare technology assessment (HTA) in Spain, Germany, Sweden, the UK and France in terms of safety, efficacy, effectiveness and efficiency and compares and contrasts HTA in the five different settings. With the support of Novartis, this book evaluates and identifies best practices in the area of HTA.

Spanish pharmaceutical policy: what role does economic evaluation play?

The current economic crisis has instigated a focus on economic evaluation for health policy decision making, which has led to new legislation for pricing and financing of medicines and other health products. This report, with funding from AstraZeneca, discusses cost-effectiveness analyses and quality-adjusted life years (QALY) in the Spanish pharmaceutical sector.



The "fourth hurdle": is NICE applicable to Spain?

With increased pressure due to limited resources, health systems around the world are paying more attention to rising pharmaceutical costs. In collaboration with AstraZeneca, this report analyzes the applicability to Spain of NICE (The National Institute for Clinical Effectiveness) in the UK, which has had more than 10 years´ experience with the 'fourth hurdle' (what a pharmaceutical, medical technology or biotech product has to fulfill in order to be covered by the national health system, which makes it both clinically- and cost-effective). This review includes both NICE´s successes as well as its limitations.

Being a doctor. The values of a profession.

This book presents a holistic picture of "being a doctor" and the values of the medical profession. It provides an in depth analysis from varying points of view by renowned and experienced health researchers and doctors of what makes this profession different from others and why this is so. With support from the Lilly Foundation, this volume first considers the underlying values and ethics of the profession, and then focuses on important components and elements of what it means to be a doctor in practice.

Regulating the price of medicines through value-based price setting

The aim of this study was to develop a proposal for improving the price setting of medicines in Spain, with particular emphasis on value-based price setting. In collaboration with Lilly, the report reviewed the literature on price setting in OECD and EU countries, categorizing countries into different groups. Research also included an analysis of the Spanish medicines market, its regulation, and discussion by interested Spanish experts regarding options for introducing value-based price setting in Spain.

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