Value-Based Evaluation of Chinese Provincial Health Insurance Policy Schemes

Since 2011, an international group of health policy experts has been working on a value-framework to be used for pharmaceutical policy decisions based on multicriteria decision analysis (MCDA). This tool can be easily adapted to a local decision-making context through a facilitated workshop format. Several workshops have been conducted in emerging markets to test the acceptance and feasibility of using MCDA in local decision-making. In China, national policy goals for expanding health-care coverage pressure the provincial governments to implement more comprehensive coverage schemes. This chapter demonstrates the adaptation of a global value-framework to the local policy environment. In September 2018, nine leaders from provincial health insurance bureaus responsible for the urban employee basic medical insurance (UEBMI) participated in a 1-day workshop to build a consensus on the most important objectives for the health-care reform and to translate these into measurable criteria. The participants ranked the criteria by importance and MCDA methodology was used for weighing the importance of each criterion in the final decision. The model driving this process will be presented and discussed by comparing two policy options for health-care reform

Chapter Value-Based Evaluation of Chinese Provincial Health Insurance Policy Schemes

Since 2011, an international group of health policy experts has been working on a value-framework to be used for pharmaceutical policy decisions based on multicriteria decision analysis (MCDA). This tool can be easily adapted to a local decision-making context through a facilitated workshop format. Several workshops have been conducted in emerging markets to test the acceptance and feasibility of using MCDA in local decision-making. In China, national policy goals for expanding health-care coverage pressure the provincial governments to implement more comprehensive coverage schemes. This chapter demonstrates the adaptation of a global value-framework to the local policy environment. In September 2018, nine leaders from provincial health insurance bureaus responsible for the urban employee basic medical insurance (UEBMI) participated in a 1-day workshop to build a consensus on the most important objectives for the health-care reform and to translate these into measurable criteria. The participants ranked the criteria by importance and MCDA methodology was used for weighing the importance of each criterion in the final decision. The model driving this process will be presented and discussed by comparing two policy options for health-care reform

Considering Multicriteria Decision Analysis (MCDA) Simple Scoring as an Evidence-Based HTA Methodology for Evaluating Off-Patent Pharmaceuticals (OPPs) in Emerging Markets

Off-patent pharmaceuticals (OPPs) represent more than 60% of the pharmaceutical market in many emerging countries, where they are frequently evaluated primarily on cost rather than with health technology assessment. OPPs are assumed to be identical to the originators. Branded and unbranded generic versions can, however, vary from the originator in active pharmaceutical ingredients, dosage, consistency formulation, excipients, manufacturing processes, and distribution, for example. These variables can alter the efficacy and safety of the product, negatively impacting both the anticipated cost savings and the population?s health. In addition, many health care systems lack the resources or expertise to evaluate such products, and current assessment methods can be complex and difficult to adapt to a health system?s needs. Multicriteria decision analysis (MCDA) simple scoring is an evidence-based health technology assessment methodology for evaluating OPPs, especially in emerging countries in which resources are limited but decision makers still must balance affordability with factors such as drug safety, level interchangeability, manufacturing site and active pharmaceutical ingredient quality, supply track record, and real-life outcomes. MCDA simple scoring can be applied to pharmaceutical pricing, reimbursement, formulary listing, and drug procurement. In November 2015, a workshop was held at the International Society for Pharmacoeconomics and Outcomes Research Annual Meeting in Milan to refine and prioritize criteria that can be used in MCDA simple scoring for OPPs, resulting in an example MCDA process and 22 prioritized criteria that health care systems in emerging countries can easily adapt to their own decision-making processes

Feasibility and validity of the Health Status Classification System-Preschool (HSCS-PS) in a large community sample: The Generation R study

Objectives To evaluate the feasibility, discriminant validity and concurrent validity of the Health Status Classification System-Preschool (HSCS-PS) in children aged 3 years in a large community sample in the Netherlands. Design/setting A prospective population-based cohort in Rotterdam, the Netherlands. Participants A questionnaire was administrated to a sample of parents of 4546 children (36.7±1.5 months). Outcome measures Health-related quality of life (HRQOL) of children was measured by HSCS-PS. The HSCS-PS consists of 10 original domains. Two single-item measures of General health' and Behavior' were added. A disability score was calculated by summing up all 10 original domains to describe the overall health status. Feasibility was assessed by the response rate, percentages of missing answers, score distributions and the presence of floor/ceiling effects. Discriminant validity was analysed between subgroups with predefined conditions: low birth weight, preterm birth, wheezing, Ear-Nose-Throat surgical procedures and behaviour problems. In the absence of another HRQOL measure, this study uses the single-items General health' and Behavior' as a first step to evaluate concurrent validity of the HSCS-PS. Results Feasibility: response rate was 69%. Ceiling effects were observed in all domains. Discriminant validity: the disability score discriminated clearly between subgroups of children born with a very low birth weight', very preterm birth', with four or more than four times wheezing', at least one ear-nose-throat surgical procedures', behaviour problems present' and the reference' group. Concurrent validity: HSCS-PS domains correlated better with hypothesised parallel additional domains than with other non-hypothesised original domains. Conclusions This study supports the feasibility and validity of the HSCS-PS among preschoolers in community settings. We recommend developing a utility-based scoring algorithm for the HSCS-PS. Further empirical studies and repeated evaluations in varied populations are recommended

Health care systems in Sweden and China: Legal and formal organisational aspects

<p>Abstract</p> <p>Background</p> <p>Sharing knowledge and experience internationally can provide valuable information, and comparative research can make an important contribution to knowledge about health care and cost-effective use of resources. Descriptions of the organisation of health care in different countries can be found, but no studies have specifically compared the legal and formal organisational systems in Sweden and China.</p> <p>Aim</p> <p>To describe and compare health care in Sweden and China with regard to legislation, organisation, and finance.</p> <p>Methods</p> <p>Literature reviews were carried out in Sweden and China to identify literature published from 1985 to 2008 using the same keywords. References in recent studies were scrutinized, national legislation and regulations and government reports were searched, and textbooks were searched manually.</p> <p>Results</p> <p>The health care systems in Sweden and China show dissimilarities in legislation, organisation, and finance. In Sweden there is one national law concerning health care while in China the law includes the "Hygienic Common Law" and the "Fundamental Health Law" which is under development. There is a tendency towards market-orientated solutions in both countries. Sweden has a well-developed primary health care system while the primary health care system in China is still under development and relies predominantly on hospital-based care concentrated in cities.</p> <p>Conclusion</p> <p>Despite dissimilarities in health care systems, Sweden and China have similar basic assumptions, i.e. to combine managerial-organisational efficiency with the humanitarian-egalitarian goals of health care, and both strive to provide better care for all.</p