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

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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 92
OHE Consulting Report for PhRMA 5 January 2011 schemes, depending on local circumstances, with more prosperous regions providing a higher level of drug benefit. Whilst there is growing interest in the potential importance of evidence-‐based clinical practice guidelines in managing chronic disease, it is not clear that HTA is playing any role in the development of guidelines. The new MoU between the MoH and the UK NICE may initiate greater use of guidelines to better manage chronic disease. The focus for the use of economics is on HTA for “micro-‐technologies” rather than looking at other “macro” aspects of system architecture which may yield higher gains such as reform to hospital payment systems and to the drug distribution process. China’s current strategy is to increase the public sector share of health spending in order to provide affordable access to basic health care for its population. Once this is achieved there will then be questions as to: how the minimum package increases over time; the extent of heterogeneity of benefits offered to different population groups and geographical areas within the public schemes; and the extent to which people “top up” the public system with additional services purchased through supplementary insurance or out-‐of-‐pocket. 93
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