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

OHE Consulting Report for PhRMA
5 January 2011
the ability of their Department to generate additional income from the sale of extra services. Given
the ability to earn much-­‐needed revenue off of the margins allowed in pharmaceutical sales,
hospitals therefore tend to provide incentives to doctors to over-­‐prescribe. Not unsurprisingly
there is drug over-­‐prescription, and inconsistent prescription has become a serious problem.
The government has recognized this problem and are working to phase out mark-­‐ups allowed on
pharmaceutical sales, including on the co-­‐pays that patients pay. This is being presented as a benefit
of health care reform – lower drug prices for patients. But it creates challenges for hospital finances.
The MoH is proposing to introduce a dispensing fee (an Rx service fee) to tackle the problem, i.e.
replacing a 15% hospital percentage mark up with a flat rate (10 RMB or $1.50) per-­‐item charge
which would remove the incentive to prescribe higher priced drugs but not the incentive to
overprescribe. This reform is being presented as a price cut for patients (in the form of lower co-­payments)
and so as a benefit of health reform. Logically the fee schedule for other things could go
up, but this would be seen as a price increase for patients via the co-­‐payment so is difficult for the
MoH to implement.
To expect that the NDRC can oversee thousands of medical products and services and to efficiently
control their prices under a fee-­‐for-­‐service schedule that covers all of China seems to be unrealistic.
Arguably, prices need to be decentralized in order to solve this problem. However, this presupposes
the introduction of effective purchasing and incentives for quality and efficiency, which can drive
reform to the delivery system that is suitable for a population with increasing chronic conditions and
reduce inefficiencies. It needs to integrate prevention, primary and hospital care, and re-­‐orient care
away from hospitals to primary and community based care.
The need for the active purchasing of population health care.
There is little understanding within the health care system nationally and locally of purchasing and
contracting for health care services and it is unclear how improvements in delivery integration and
efficiency can be brought about. There are experiments in some provinces with:
provider payment methods linked to the use of clinical protocols for some of the most
prevalent health conditions,
the design of a benefit package to reduce financial barriers to access care and to motivate
patients to use primary-­‐based care;
use of technology (e.g. mobile phone) to improve patient compliance;
the conduct of patient education programmes on prevention, healthy lifestyle and best-­practice
care.
A note on one experiment in Ningxia province is included in an Annex to this Appendix.
There are efforts to develop clinical practice guidelines, and the MoH is seeking around 400 clinical
guidelines of which around 100 have been published. These have mostly been developed over a
short period by the Teaching Hospital at Beijing University and draw on relevant guidelines from
other health care systems. Hospitals in the Provinces have also been asked to develop guidelines.
However, it is not clear whether there is an agreed protocol for the development of national or local
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