High health official

High health official ( HAS ) begins again, since 2005, missions of National agency of accreditation and of evaluation in health (ANAES), those of Commission of transparency (authority scientific which evaluates the drugs having obtained their marketing authorization), of Commission of evaluation of products and services (scientific authority which examines the products and services for their refunding by the Health insurance) and of the Fonds of promotion of the medical information and médico-economic (FOPIM - authority charged to provide in a way independent information of the doctors).

It is about an organization of scientific report, advisory, public and independent. It is charged to evaluate the medical utility of the whole of the acts and services dealt with by the health insurance, it implements the certification of the health care institutions. The HAS makes recommendations and delivers opinions independent, impartial and making authority. They make it possible to improve quality of the professional practices and the care lavished to the patient.

He is established with the Plaine Saint-Denis

The HAS was to create in answer to the need “for more structuring operation of the health-care system, for testing the quality and the utility of what one refunds and to enter demanding steps of evaluation of the practices and accreditation” declared in the report/ratio of the High council for the future of the health insurance of January 23rd, 2004. It was installation on January 1st, 2005. The particularly significant sector of health indeed had emitting need for a structure in an independent way without any influence that they are (of political, administrative or different natures) of the opinions and recommendations making authority such as SCUMS does it for the sector of the audio-visual one.

The principles founders

The HAS rests on three principles founders which are: independence, the scientific rigor and transversality.

1) Independence: The HAS is a specialized company placed apart from the administrative structures traditional and not subjected to the hierarchical capacity. It belongs to the body of the independent administrative authorities (standard SCUMS, ART, CNIL, etc). The independence of the given opinions and the made recommendations is guaranteed by: - the statute of the HAS (“independent public authority”) and the absence of ministerial supervision; - financial autonomy; - mode of nomination of the members of the College, named, at a rate of two each one, per more the high ranking authorities of the State; - their professional diversity and their representativeness; - the abandonment of their other mandates and professional responsibilities which could have created conflicts of interest; - practice of the collegial structure in the processes of validation and decision making; the existence of an internal code of deontology. These provisions constitute guarantees of independence with respect to the pressures industrial, administrative, political and professional and thus of impartiality of the messages, the opinions and the recommendations diffused.

2) The scientific rigor: The evaluations and recommendations worked out by the HAS are based on scientific arguments, particularly on the concept of “scientific level of proof”, like on studies concerned with the social sciences (studies sociological, demographic, etc) and of the economic studies.

They are based on the most current data of the scientific literature and reflect the state of knowledge at a given time. They are carried out using a rigorous methodology, clarifies, reproducible and without a priori, i.e. not being based on an opinion already made up.

3) Transversality: The missions entrusted to the HAS relate to all the organization of the care. The comprehensive approach and transversal of the subjects make it possible to make comparisons of products, techniques, professional practices, structures and of organization, to coordinate the various fields of study and thus to profit from a broad and coherent observation field on the whole of the health-care system. This approach contributes to a better coherence of the evaluation and given opinions and makes it possible to propose to the health professionals a panel tools of improvement of the quality of the care, bearing on the whole of the care. According to the problems and topics approached, the HAS calls upon the expertise of other organizations of health: medical agencies (French Agency of public health of health products (AFSSAPS), Arranges French public health of food (AFSSA), National Sanitary Surveillance Institute (INVS), etc), the National institute of prevention and education for health (INPES) or other organizations scientific (INSERM, National institute of cancer, etc).

Missions of the HAS

Since January 2005, the High health official takes again the missions of several organizations, these last are thus multiple. Thus we will more precisely clear up the relative missions during quality.

The detail of its missions is explained in the decree n°2004-1139 of October 26th, 2004. This new structure aims “to look at, to evaluate but also to make progress the quality of the care to France. ”

The evaluation of the service awaited or returned products, acts and services of health

It is a question of evaluating the service awaited or returned products acts and services of health dealt with by the Health insurance. The HAS give opinions which will be able to help with the improvement of the health-care system.

The evaluation of refunding

The HAS evaluates the legitimacy of refundings of a whole of products, acts, care, services. On its own initiative or at the request of certain organizations working in collaboration with the HAS, it works out recommendations aiming at tallying the conditions of refunding of these same products, acts, care and services.

The evaluation of professional practices (EPP)

This mission is centered on 3 great aspects.

The individual evaluation of the professional practices

The HAS sets up the procedure of individual evaluation of the professional practices. Aiming at the doctors, this procedure is obligatory. Sanctions are envisaged in the code of the social security for the nonco-operative doctors. The HAS entitles the doctors charged to evaluate their pars by this procedure. Actions of evaluation of the practices of the ancillary medical professionals are also organized.

The accreditation of the doctors and the medical teams

The accreditation is a procedure of evaluation external to an health care institution, carried out by professionals independent of the establishment and its organizations of supervision, evaluating the whole of its operation and its practices. It aims at ensuring the safety and the quality of the care given to the patients, but is not obligatory. It relates to the whole of the private or public health care institutions (more than 3000 establishments). Reference frames of quality (determined by the HAS) make it possible to evaluate these doctors. This accreditation is valid 4 years. The HAS defines the procedure of accreditation, entitles the doctors charged to evaluate their fellow-members.

Procedure of evaluation and certification of the quality of the medical visit

It is a question here of regulating the promotion and the publicity of the drugs. Indeed, a charter of quality of the professional practices of the people in charge of the promotion of the proprietary medical products can be signed by the professionals of pharmacy. According to a procedure established by the High health official, the professionals having signed this charter must make evaluate and certify by accredited organizations quality and conformity with this charter of the medical visit which they organize or which they finance.

The certification of the health care institutions

The law of August 13rd, 2004 replaces the “accreditation” by the “certification” before used for the health care institutions. The term “accreditation” from now on is reserved for the accreditation of the doctors and the medical teams. Certification was created in a logic of progress for the establishment. It aims at evaluating the quality and the safety of the care exempted by the public and deprived health care institutions, the networks of care and the centers of care. Thus, it evaluates for example the delivered services, the internal organization of the establishments, the satisfaction of the patients. In fact the HAS delivers certifications.

The information of the health professionals and the public on the good use of the care and the good practices

By the creation and the diffusion of guide of good use of the care and recommendations of good practice for all the health professionals, the HAS contributes to the information of the health professionals and the general public. Within this framework, the authorities also entrusted to the HAS the mission “Information, development of the mediation on the infections nosocomiales” (Idmin). Its goal is to inform and, to listen, the general public as for the risks of infection nosocomiale (infection which occurs following medical care). A dialog between the users and the health professionals must begin during this mission. The fight against the diseases nosocomiales is a priority for the public health.

The certification of Internet sites health and the medical software

The HAS takes care that Internet sites dedicated to health and the software of assistance to the medical regulation comply with the rules of good practices. For that, it delimits the rules of good practices and certifies these sites and software.

The evaluation of the quality of the medical assumption of responsibility of the population

This mission consists in evaluating the actions of public health installation a posteriori. It recovers the whole of the missions. These actions relate to the professional practices, the organization of the health systems, the prevention programs and of education for health, the care… Thus, after having to analyze these various actions, of the projects of improvement could be set up.

Within the framework of the whole of these missions, the HAS requires to realize or makes an any study appearing necessary. Always within the framework of its missions, it can also inform the ministry for the health of any act having a potential risks serious.

The operation of the HAS

The college

The HAS is organized around a college. These main objectives are:

to organize the work of the commissions,
to define the field of their responsibilities,
to deliver opinions on the medical devices and the drugs
to treat the received requests and the methods of deliberation
to adopt the budget of the HAS
to organize the services
to carry out an annual progress report for the Parliament and the government
to draw up the list of the composition and the rules D operation of the commissions

The college is composed of 8 members of which a president. The members are designated by the president of the republic, the presidents of the National Assembly, the senate and the Economic and Social Council. They are named for 6 years per Presidential decree of the republic. The opinions and the recommendations of the college aim at clarifying the public decision for example to inform on the decisions of refunding of the products and medical departments, to improve quality of the professional practices and the care of the patient. (cf Missions)

The recommendations fixed by the college are not inevitably made with its initiative. They can be following the request for a ministry, organizations or associations.

Committees

The HAS is made up of 7 Committees, each one having like chair a member of the college. The seven commissions are:

“evaluation of the professional acts”
“evaluation of the drugs”
“evaluation of the devices and technology of health”
“perimeter of the goods and services refundable”
“recommendations for the improvement of the practices”
“quality of the medical information and diffusion”
“certification of the health care institutions”

The president of each commission is in charge of the policy, the strategy and the executive of his commission.

Personnel and services

The HAS includes/understands:

4 operational directions
2 networks of experts and professionals
1 general secretary
1 countable agency

The HAS is made up of 350 permanent agents of which 135 are health professionals (doctors, pharmacists…). Moreover, 175 correspondents in area diffuse work of the HAS and 800 expert-visitors accredit health care institutions.

On the whole, each year, nearly 3000 professionals collaborate with the HAS according to their competence. Thus each health professional is represented with the HAS.

Budget of the HAS

In 2005, the budget rose to 59 million euros. It comes from State grant, of the health insurance, contribution of the health care institutions within the framework of the accreditation, of the taxes of the public health and equities.

Notes and references of the article

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