The Evolution of HTA in Emerging Markets Health-Care ... - TREE

OHE Consulting Report for PhRMA
5 January 2011
competitive pressure. Economic liberalisation also weakened the tax base and hence the ability of
governments to directly subsidise hospital and other health care facilities. Such government support
as did remain was directed at better off workers (on the demand side), i.e. those working for the
government or the more secure SOEs, and (on the supply side) at urban hospitals. There was further
geographical inequity as the poorer provinces lagged behind in income growth and interregional
transfers via the central government lagged behind the growth of the economy
Hospitals/health facilities were given “financial autonomy” which meant they supplied “basic
services at a loss (these were price controlled) and made profits on drugs and “high tech” care
through a policy of charging for these non-­‐basic services. Barefoot doctors who used to provide first-­level
[primary] care to the agricultural commune and workplace clinics, set up private village clinics
as there was no longer communal funding to support them. Even utilisation of more basic health
care services started to fall as health centres began charging even for public health services such as
EPI and TB (outside of DOTS).
Thus economic liberalisation reduced people’s access to healthcare (measured in terms of utilisation
rates) and increased the risk of them incurring large out-­‐of-­‐pocket expenditures when they did
obtain access. Analysis seems to suggest that the main problems that emerged were:
high out-­‐of-­‐pocket payments;
high costs of health care, with inefficiencies due to long hospital stays, overuse of drugs, and
overuse of interventions such as caesarean sections and MRIs scans, as providers sought to
compensate for reductions in government and insurance scheme payments (and artificially
low prices for those services that were paid for) by charging for additional services.
Consequences of the erosion of coverage and of public funding were that:
Whilst China’s economic growth was high, its mortality rates were not failing in a way that
reflected this. China now has heart disease, chronic lung disease, stroke, diabetes, cancer,
and hypertension as a result of increased intake of fat, sugar, and calories, more smoking,
accompanied by less exercise.
health expenditures have placed a growing burden on poorer families, with evidence from
2003 indicating that out of pocket spending on health pushed an additional 19% of families
below the $1.08 poverty line, with 76% and 79% respectively of the lowest income urban
and rural populations being without any insurance cover, resulting in them spending 10%
and 21% of their income respectively on medical expenditures (China MOH, 2003)
public health in terms of primary care prevention, for which China had a high reputation,
began to be neglected in the 1980s and 90s, and public health surveillance declined likewise,
hence HIV/AIDS, SARS and Avian Flu were not dealt with well and China has struggled to
tackle TB and viral hepatitis.
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