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China & asia health systems Prof. Dr. Chang liu

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Prof. Liu gives an overview and insight into the healthcare system of China.
3 periods, 1949-1978, 1978 - 2008 and 2009 till now. They spend 17x less then the USA and have the same life expectancy. What can we expect in terms of innovation? A thorough view..

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China & asia health systems Prof. Dr. Chang liu

  1. 1. Our vision is that all people, no matter where they live, have a right to access high quality, affordable healthcare and to lead healthy and productive lives. Chang Liu Beijing 2018.11 Health Systems in China and Asia Pacific Delivery System Reform, New Financing Models, and Digital Revolutions
  2. 2. As a “Global Health Innovation Partner” , ACCESS Health International focuses on building networks and generating knowledge for health and aging innovation. OUR VISION WHO WE ARE All people, no matter where they live, no matter what their age, have a right to access high quality and affordable healthcare. LOCATIONS Mainland China Hong Kong (China) Singapore United States Sweden Netherland India Philippines
  3. 3. • Health systems in China and Asia Pacific: Rapid aging, Stressed systems, Funding gaps • Trend 1 System transformation: towards more patient centered/ integrated care • Trend 2 Disruptions with new technologies and digital solutions • Trend 3 Innovative financing models through partnerships
  4. 4. The Regional Challenges in Health Systems Rapid aging Stressed systems Funding gap
  5. 5. Demographic Challenges • The number and proportion of highly disabled elderlies are rising. 0 5.000 10.000 15.000 20.000 25.000 30.000 35.000 40.000 45.000 50.000 2010 2015 2020 2025 2030 Persons Year 5-7 ADL limitations 3-4 ADL limitations Source: Ansah JP, Matchar DB, Love SR, et al. 2013. 1-2 ADL limitations
  6. 6. Demographic Challenges • The number and proportion of highly disabled elderlies are rising. • Family are getting smaller Source: Ansah JP, Matchar DB, Love SR, et al. 2013. 1-2 ADL limitations 1 2 3 4 5 6 7 2011 2014 2017 2020 2023 2026 2029 Children Year Age 60 Age 70 Age 80
  7. 7. Demographic Challenges • The number and proportion of highly disabled elderlies are rising. • Family are getting smaller • More caregivers will have significant depression attributable to caregiving Source: Malhotra C, Malhotra R, Østbye T,,et al. 2012. 1-2 ADL limitations 0 2000 4000 6000 8000 10000 12000 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 Individuals with depression attributable to caregiving Individuals with depression irrespective of caregiving
  8. 8. The Regional Challenges in Health Systems Rapid aging Stressed systems Funding gap 04 6AM at a public hospital
  9. 9. Achievements before 1980 During the period between 1950 to 1978, China had many achievements in health field to be proud of: • Achieved rapid and large reductions in mortality rate, despite China’s low income per capita at the time • Created a low cost, wide coverage primary health care model
  10. 10. Unsatisfied development after 1980 After 30 years of economic reform, China’s healthcare system has not improved as well as the economy has. Instead, it has deteriorated in many aspects: • Medical costs are escalating rapidly • The relationship between patients and doctors are deteriorating
  11. 11. The GHE decreased since the late 1980s and has returned to increase since the early 2000s ( SARS in 2003). Source: Chinese Health Statistics Yearbook 2011 Market reform in health sector: 1985 SARS, New reform (NCMS): 2003 Healthcare expenditure and reforms 13
  12. 12. Chinese Healthcare Reform Phase I • Speed up the establishment of a universal health insurance system • Set up an essential drug system • Improve the primary health service network • Provide equal access to public health care for urban and rural residents • Public hospital reform 14
  13. 13. 健康体系的全球性挑战
  14. 14. The Regional Challenges in Health Systems Rapid aging Stressed systems Funding gap Source: New funding models for cancer treatment in Asia report by ACCESS Health International
  15. 15. The Regional Challenges in Health Systems Rapid aging Stressed systems Funding gap 05
  16. 16. 健康体系的全球性挑战
  17. 17. • Health systems in China and Asia Pacific: Rapid aging, Stressed systems, Funding gaps • Trend 1 System transformation: towards more patient centered/ integrated care • Trend 2 Disruptions with new technologies and digital solutions • Trend 3 Innovative financing models through partnerships
  18. 18. Health Systems Transformation Keywords: Connected & integrated People-centered High quality Value-based Affordable Sustainable Trend 1 System transformation: towards more patient centered/ integrated care
  19. 19. Health Systems Transformation Keywords: Connected & integrated People-centered High quality Value-based Affordable Sustainable Polyclinic Specialty Outpatient Clinic Acute Hospital Community services General Practitioner Service integration Transitional care Community Services General Practitioner Polyclinic Specialty Outpatient Clinic Acute Hospital Enhanced Community services Self-care Family Medical Clinic/ Community Health Center Population health and disease prevention Post acute care and disease management The Singapore Model Trend 1 System transformation: towards more patient centered/ integrated care
  20. 20. Pilot programs and national reforms for integrating hospital care, primary care and post- acute care Linkage Coordination Integration National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke • To enhance referral and communication between hospital and primary care systems • No structural change of existing organizational units India Philippines Kalusugan Pangkalahatan (a universal healthcare scheme) • To improve care coordination among various parts of the health system • Adoption of common technology standards and provision Singapore Regional Healthcare System model • To better integrate primary, intermediate and long-term care services • Agency for Integrated Care established in 2009 • Transformation office in MOH China Medical Consortium model • To coordinate public tertiary hospitals, secondary hospitals and community healthcare centers • Through clinical information sharing and transition management Intensity Source: Integrated Care study in Asia by ACCESS Health International supported by WHO Trend 1 System transformation: towards more patient centered/ integrated care
  21. 21. China: “Healthy China 2030” 中国 《健康中国2030》 Singapore: Action Plan for Successful Ageing 新加坡 《成功老龄化行动方案》 China: promote “Hierarchical Medical System” 《国务院办公厅关于推进分级诊疗制度建设的指导意见》 Source: Integrated Care study in Asia by ACCESS Health International supported by WHO Trend 1 System transformation: towards more patient centered/ integrated care
  22. 22. Hong Kong 2030+ 香港 《香港2030+》 Other regional policies Source: Integrated Care study in Asia by ACCESS Health International supported by WHO Trend 1 System transformation: towards more patient centered/ integrated care
  23. 23. • Health systems in China and Asia Pacific: Rapid aging, Stressed systems, Funding gaps • Trend 1 System transformation: towards more patient centered/ integrated care • Trend 2 Disruptions with new technologies and digital solutions • Trend 3 Innovative financing models through partnerships
  24. 24. 26 Trend 2 Disruptions with new technologies and digital solutions
  25. 25. Life style and wellness Safety and access Finance Rehab/Care Health Management Medical care Demand side Categorization Supply side Categorization Services Products Channels Training ACCESS Health International Trend 2 Disruptions with new technologies and digital solutions
  26. 26. Source: Goldman Sachs Global Investment Research Trend 2 Disruptions with new technologies and digital solutions
  27. 27. Digital Health and Health Tech Booming in China and ASEAN More Players Categories Examples Tech MNCs IBM Watson, Microsoft Intel, Google, Apple Asian Leading Tech Companies Tencent, Alibaba, Baidu Grab, Didi Insurance and Fintech Pingan Insurance, Metlife, Mercer Zhongan Technology, Ant Finance Telecom China Mobil, Singtel Distributors Shanghai Pharma Startups Chunyu, Almond doctor, Linkdoc, Medilink Practo, Mydoc, Allied World Healthcare, Possible Health, ThinkMD Selected Digital Health Players in China and ASEAN Trend 2 Disruptions with new technologies and digital solutions
  28. 28. Digital Health and Health Tech Booming in China and ASEAN More Players More enablers/ More collaborators Categories Examples Health data companies China Electronics, China Mobil, Shenzhou Data, YiduCloud Technology platforms Xiaomi, Cisco, Qualcomm Apple, Intel, Microsoft, Huawei Insurance companies Taikang, Pingan, Zhongan Insurance SwissRe, Metlife, Mercer Pharma Pfizer, Novartis, Lily, Sanofi MSD, Bayer Distributors China Pharma, Zuellig Pharma Service provider groups Regional health systems in Singapore, Medical consortiums in China, Private hospital groups Selected Enablers and Collaborators for Health Tech Solutions in China and ASEAN Trend 2 Disruptions with new technologies and digital solutions
  29. 29. Digital Health and Health Tech Booming in China and ASEAN More Players More enablers/ More collaborators More supportive Policies More business (models) Selected Policies on “Internet+ Healthcare” in China Trend 2 Disruptions with new technologies and digital solutions
  30. 30. Health and Wellness Wearable Disease Management Registration Cloud Hospital Telemedicine Physician Communications Information Education Genetic Screening Health Screening Online Pharmacy E-Insurance E-Payment Imaging AI Software Big Data …
  31. 31. Possible Health is a non-governmental organization that delivers healthcare through public-private partnership agreements with the Government of Nepal. 17 New technologies and digital solutions to support delivery model reform
  32. 32. • Health systems in China and Asia Pacific: Rapid aging, Stressed systems, Funding gaps • Trend 1 System transformation: towards more patient centered/ integrated care • Trend 2 Disruptions with new technologies and digital solutions • Trend 3 Innovative financing models through partnerships
  33. 33. • “Strategic” • payment systems that create deliberate incentives • selective contracting • quality improvement and rewards • price and quality maker Strategic Trend 3 Innovative financing models through partnerships Public payers: moving from passive to strategic purchasing • To align incentives • To optimize limited resources • “Passive” • resource allocation using norms • little/no selectivity of providers • little/no quality monitoring price and quality taker) Passive
  34. 34. Country Agencies and Initiatives China Gates foundation, NICE China HTA Center China Health Insurance Bureau Singapore Agency for Care Effectiveness; CoRE at Duke NUS Thailand Health Interventions and Technology Assessment Programme (HITAP) Philippines Department of Health – HTA Taskforce Regional initiatives Asia-Pacific Regional Capacity Building for HTA (ARCH) Initiative HTAsiaLink (Thailand, Taiwan, Korea) Trend 3 Innovative financing models through partnerships Public payers: moving from passive to strategic purchasing Private payers: more players from diversified background • Insurers / Reinsurers / Digital Insurers • Brokers / Insurer Tech Companies • Technology Companies / Health Data Companies / Distributors / Health Services Providers
  35. 35. “Our research reveals that out of the 38 innovative models identified, 74% are partnerships.” —— ACCESS Health Study on innovative cancer financing models Partnership Examples Public private partnerships “My Child Matters” program, Sanofi and the government of Philippines (the Philippines) Cross industry partnerships Between Pharmaceutical or health diagnostic companies and private insurers (China) Nonprofit-Private partnerships Dr. Reddy’s “Sparsh “program (India) “Ating Didbin” program (the Philippines) Government-International organization partnerships the HPV initiative (Vietnam) the “Vajpayee Arogyashree scheme” (India) Source: New funding models for cancer treatment in Asia report by ACCESS Health International Trend 3 Innovative financing models through partnerships
  36. 36. Health systems in Asia Pacific: the regional challenges Rapid aging, Funding gaps, Stressed systems Trend 1 System transformation: towards more patient centered/ integrated care Trend 2 Disruptions with new technologies and digital solutions Trend 3 Innovative financing models through partnerships Opportunities: Develop more holistic and people centered service packages Embrace digital health and innovative health technologies Prepare for payment reforms and explore new partnerships
  37. 37. Health Futures Innovation Platform bringing together partners from across sectors to envision healthcare of the future, one that is connected, people centered, value based, affordable, and accessible. Health Futures Innovation Platform
  38. 38. Our vision is that all people, no matter where they live, have a right to access high quality, affordable healthcare and to lead healthy and productive lives. Chang Liu Beijing 2018.11 Health Systems in China and Asia Pacific Delivery System Reform, New Financing Models, and Digital Revolutions

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