Deciphering the Sunshine Act: Transparency Regulation and Financial Conflicts in Health Care

Price transparency in Iranian healthcare market

Insufficient price transparency has emerged as a pivotal contributor to patient dissatisfaction, escalating costs, and diminished productivity within Iran's health system. This study aims to delineate and elucidate a definition of price transparency, identify suitable strategies, and present the outcomes associated with establishing a health system that embraces transparent pricing while also addressing the challenges ahead. Employing a quantitative-qualitative research design, data were extracted from a semi-structured interviews with stakeholders. A purposive sampling method, encompassing sequential and snowball techniques, was employed to capture the perspectives of all stakeholders involved in the issue of price transparency in Iran. The interview data were analyzed using the grounded theory approach was classified into three categories: price transparency before, during, and after the receipt of healthcare services. Our findings reveal the causes of low price transparency, strategies to address the issue, and the consequences associated with increased levels of transparency. Ultimately, we contend that health systems can significantly enhance efficiency, patient satisfaction, and the performance of health insurance by adopting transparent pricing for health services, thus obviating the need for resource-intensive restructuring efforts.

Policies on doctors' declaration of interests in medical organisations: a thematic analysis

OBJECTIVES

There has been growing concern about doctors' conflicts of interests (COIs) but it is unclear what processes and tools exist to enable the consistent declaration and management of such interests. This study mapped existing policies across a variety of organisations and settings to better understand the degree of variation and identify opportunities for improvement.

DESIGN

Thematic analysis.

SETTING

We studied the COI policies of 31 UK and international organisations which set or influence professional standards or engage doctors in healthcare commissioning and provision settings.

PARTICIPANTS

31 UK and international organisations.

MAIN OUTCOME MEASURES

Organisational policy similarities and differences.

RESULTS

Most policies (29/31) referred to the need for individuals to apply judgement when deciding whether an interest is a conflict, with just over half (18/31) advocating a low threshold. Policies differed on the perception of frequency of COI, the timings of declarations, the type of interests that needed to be declared, and how COI and policy breaches should be managed. Just 14/31 policies stated a duty to report concerns in relation to COI. Only 18/31 policies advised COI would be published, while three stated that any disclosures would remain confidential.

CONCLUSIONS

The analysis of organisational policies revealed wide variation in what interests should be declared, when and how. This variation suggests that the current system may not be adequate to maintain a high level of professional integrity in all settings and that there is a need for better standardisation that reduces the risk of errors while addressing the needs of doctors, organisations and the public.

Financial Conflicts of Interest of United States-Based Authors in Neurology Journals: Cross-Sectional Study Using the Open Payments Database

OBJECTIVE

To detail the scope, nature, and disclosure of financial conflicts of interest (COI) between the pharmaceutical and medical device industries (Industry) and authors in high-impact clinical neurology journals.

METHODS

Using the Centers for Medicare and Medicaid Services Open Payments Database (OPD), we retrieved information on payments from Industry to 2,000 authors from randomly selected 2016 articles in 5 journals. We categorized payments by type (research, general, and associated research/institutional), sponsoring entity, and year (from 2013 to 2016). Each author's self-disclosures were compared to OPD-listed Industry relationships to measure discordance. Payments were manually reviewed to identify those from manufacturers of products that were directly tested or discussed in the article. We also quantified the prevalence and value of these nondisclosed, relevant COI.

RESULTS

Two hundred authors from 158 articles had at least 1 OPD payment. Median/mean annual payments per author were $4,229/$19,586 (general); $1,702/$5,966 (research); and $67,512/$362,102 (associated research). Most neurologists received <$1,000/y (74.6%, 93.0%, and 79.5% for general, research, and associated research, respectively), but a sizeable minority (>10% of authors) received more than $10,000 per year, and several received over $1 million. Of 3,013 payments deemed directly relevant to the article, 50.9% were not self-disclosed by the authors, totaling $5,782,197 ($1,665,603 general; $25,532 research; $4,091,062 associated research).

CONCLUSION

Industry-related financial relationships are prevalent among United States-based physicians publishing in major neurology journals, and incomplete self-disclosure is common. As a profession, academic and other neurologists must work to establish firm rules to ensure and manage disclosure of financial COI.

Restricted access to innovative surgical technique related to a specific training, is it ethical? Example of the PIPAC procedure. A systematic review and an experts survey

OBJECTIVE

Using the example of Pressurized Intra Peritoneal Aerosol Chemotherapy (PIPAC), we analyse the development model of this procedure and provide an ethical analysis of the involvement of the industry in a new development.

SUMMARY BACKGROUND DATA

In the case of breakthrough innovation, medical training is essential for safe use of the new procedure. In some cases, pharmaceutical companies decide to organise this training. But when it becomes the only training opportunity to use the device, scientists and clinicians could be exposed to a conflict of interest?

METHODS

We performed a literature review of PIPAC publications using the STROBE criteria. Then, we conducted interviews with an expert panel to analyse the ethical impact of involvement of the industry in the development of the PIPAC procedure.

RESULTS

The number of publications has increased every year since the first publication in Germany, where the technology was developed in 2013. The scientific production was of good quality, with a mean STROBE score of 18.2 ± 2.4 out of 22 points. Ten of the 33 included studies declared a conflict of interest. From the interviews, the main axe concerning the implication of the industry was the training model. The company had decided that only trained and approval surgeon could perform the PIPAC procedure. All four interviewed practitioners agreed that it was initially a good way to implement the procedure safely, but later they felt uncomfortable about the control and validation by the industry.

CONCLUSION

Based on the growing number of published papers from a growing number of international centres, the controlled training model is not limiting. However, the different levels of conflict of interest complicate transparency, and we postulated that this development model is limited to the beginning of the procedure diffusion. CLINICALTRIAL.

GOV REGISTRATION

NCT04341337.