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

OHE Consulting Report for PhRMA
5 January 2011
standards for best practice, taking account of efficiency and equity considerations with the aim of
supporting the Chinese government with the ongoing Rural Health Reform, a large reform initiative
which emphasises quality, efficiency and access.”
(http://www.nice.org.uk/aboutnice/niceinternational/NICESignsMemorandumOfUnderstandingWith
ChineseMinistryOfHealth.jsp)
NICE’s work is linked to the development and use of clinical practice guidelines for the better
management of disease rather than with technology assessment (i.e. the application of HTA to a
specific drug, device or other intervention). NICE will work with the MoH over the next five years to
develop a new institution responsible for promoting quality and efficiency in healthcare across
China. This will build on the China Centre for Health and Development.
Within the MoH, the initial facilitator of HTA was the Department for Science and Education (DSE).
Within the MoH, the Department of Hospital Administration (DHA) also has some role to play in HTA
– with regards to clinical application of medical technology in ways that are consistent with the
‘principles of science, safety, effectiveness, cost-­‐effectiveness, and ethical acceptance’. DHA requires
that health technologies with ethical concerns and risks related to their use be evaluated by a third-­party
healthcare payer before their use.
In summary HTA has been adopted in terms of awareness and interest, by policy makers in China
(albeit the definition of HTA appears to cover mainly clinical evaluation of individual technologies
with little economic analysis and little consideration of treatment guidelines or of using HTA to help
reform the architecture of the health care system). Such HTA as is occurring is scattered among
many administrative areas. There is no coordination of or synergy between HTA activities being run
by different authorities. There are different HTA mandates of different authorities (including the
SFDA, MoH and MoHRSS) whose decisions affect health technology adoption in one way or the other
(Chen, Banta and Tang, 2009)
A2.7 Key Issues
There appears to be a lot of unfocussed interest in the use of HTA, primarily in the context of new
technologies rather than by any system wide focus on achieving value. In this context, HTA currently
seems to be seen as a “black box” with little thought given to appropriate use and to processes that
will ensure the involvement of stakeholders. There are also many challenges involved in collecting
economic and clinical data, not least poor infrastructure and a payment mechanism that does not
reflect cost.
As the health care system develops there is likely to be a debate about the degree of heterogeneity
that is appropriate. At the moment the Government’s main concern is to ensure increased
population access to a core of services. This is a political priority. However there are likely to remain
very different segments of the population (in terms of income). It is not obvious that a “one size fits
all” system is appropriate, given that the Government is unlikely to be able to afford a level of public
health care funding over time that would make the level of access expected by middle and higher
income groups available to the whole population. In this context a degree of heterogeneity in
provision and financing could enable differential pricing of drugs and/or the targeting of some drugs
to the increasing numbers of patients paying out-­‐of-­‐pocket or paying through private comprehensive
or supplementary insurance. There could even by differences in the willingness to pay of public
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