Value-based healthcare: A global assessment
Country snapshot from The Economist Intelligence Unit
China
With a vast population and a government that sees
healthcare as a key responsibility, cost cutting and
expanding coverage, rather than value, are priorities
China has low-cost universal health
coverage, which serves 1.3 billion people.
The system is under the control of the
National Health and Family Planning
Commission (NHFPC), and is
supplemented by several nongovernmental organisations (NGOs) and
associations such as the Chinese Medical
Association, Chinese Medical Doctor
Association, and others. Strong control
gives the country several advantages,
such as a national health technology
assessment (HTA) regulation institute,
disease registries, the use of evidencebased clinical guidance and a research
institute. Hospitals and health professionals
are strictly regulated by the NHFPC as well,
which enables China to promote new
national healthcare policies. Thus far
China has not made decisive moves
towards value-based healthcare (VBHC).
Wide coverage and central control are
the key features of China’s medical
system. The government views healthcare
as an important pillar of social equality
and stability and is responsible for twothirds of healthcare expenditures.
Meanwhile, it is focused on providing more
affordable healthcare while maintaining
quality of services. While 95% of the
population is covered by government-led
insurance, regional disparities make
delivering public healthcare a heavy and
complex burden for the Chinese
government.
China currently does not have a VBHC
system, nor does it have any policy or plan
to shift towards such a system, which is too
advanced given its relatively
undeveloped healthcare infrastructure.
China is currently more focused on
achieving universal health insurance
coverage, with a goal of covering all
citizens by 2020. Moreover, no professional
training or education is available for VBHC
and it is not a priority among other
stakeholders, such as doctors’ associations
or patient advocates. While private
hospitals have incentives to introduce
VBHC, lack of social insurance
China
Overall alignment
Low
Domains
Enabling context, policy
and institutions for value
in healthcare
Low
Measuring outcomes
and costs
Moderate
Integrated and patientfocused care
Moderate
Outcome-based payment
approach
Low
reimbursement means these hospitals
serve only one-tenth of total patients.
Easing heavy fiscal burdens, rather than
moving to patient-centric and qualitydriven services, is what is now driving
policy. China has nationwide disease
registries, administered by the Chinese
Centre for Disease Control and Prevention,
which capture regional disease data.
These data are not fully standardised or
linked, and are accessible to medical
administrative departments only under
certain conditions. China does not have a
policy that supports organising health
delivery into integrated and/or patient
focused units, nor does it have a
standardised patient outcomes data
registry with which to build a national
database.
However, the system may be ready for
incremental adoption of VBHC principles
since it is characterised by some of the soft
prerequisites for value-based care,
including comprehensive coverage of
insurance, standardisation of clinical
guidance, quality control, cost
assessments and an independent HTA
organisation. China’s efforts to promote
bundled payments such as Diagnosis
Related Groups also lay the foundation for
wider VBHC adoption. Moreover, while this
is not specifically aimed at promoting
VBHC, China is establishing interoperable,
shareable, transparent electronic health
records. Locally, especially in some big
cities, electronic health records are
available.
Note: Alignment with the core components of
VBHC was assessed according to 17 indicators
(see back of this sheet for country scores). For
more on scoring aggregation and methodology,
please see the findings and methodology report.
Commissioned by
© The Economist Intelligence Unit Limited 2016
Value-based healthcare: A global assessment
Country snapshot from The Economist Intelligence Unit
Outcomebased
payment
approach
Integrated and
patient-focused
care
Measuring outcomes
and costs
Enabling context, policy and institutions for value in healthcare
China: results
Indicator name
Unit
China’s score
1.1
Health coverage of the population
0-4
4 = Universal health coverage (or 90-100% of the population is covered
by public or private health insurance)
1.2
High-level policy or plan
Yes/No
No, there is no explicit strategy or plan either published or expressed by
the government or health ministry to move away from a fee for service
payment system towards a health system that is organised around the
patient.
1.3
Presence of enabling elements for
value-based healthcare
0-3
1 = The government or major provider(s) has implemented one of the
VBHC elements below:
(A) Outcomes-based care / patient-centred care;
(B) Bundled / block payments; payment for performance / linked to
quality;
(C) Quality standardisation
1.4
Other stakeholder support
Yes/No
No, other stakeholder support does not exist.
1.5
Health professional education and
training in VBHC
0-2
0 = No training in value-based healthcare
1.6
Existence and independence of
health technology assessment (HTA)
organisation(s)
0-2
2 = HTA organisation(s) exist with clear independence from providers
1.7
Evidence-based guidelines for
healthcare
0-4
3 = Country has established an evidence-based guideline producing
organisation, and guidelines contain a grading system that grades
evidence
1.8
Support for addressing knowledge
gaps
0-2
1 = Dedicated health-related research funding organisation
2.1
National disease registries
0-4
2 = Multiple diseases are covered in national disease registries
2.2
Patient outcomes data accessibility
0-2
1 = Disease registries exist, but there is limited accessibility to outcomes
data for research purposes
2.3
Patient outcomes data
standardisation
0-2
0 = No standardised disease registries exist
2.4
Data collection on patient treatment
costs
0-3
2 = Government and/or major payer(s) are actively collecting patient
treatment cost data in some areas (ie what the payer(s) is paying to
the provider)
2.5
Development of interoperable
Electronic Health Records
Yes/No
Yes, there is an effort on the part of the government and/or major
health provider(s) to develop interoperable EHRs.
3.1
National policy that supports
organising health delivery into
integrated and/or patient-focused
units
Yes/No
No, there is no national policy in place that supports organising health
delivery into integrated and/or patient-focused units, nor is there a
national policy that encourages a management system to follow a
patient through the entire multi-step episode of care.
3.2
Care pathway focus
0-2
2 = Three or more (3+) of the below therapy areas have coordinated
care services:
Mental health; Diabetes; HIV; Maternal health; Elderly care
4.1
Major system payer(s) promotes
bundled payments
0-3
2 = National/regional initiative to develop bundled payment system
4.2
Existence of mechanism(s) for
Identifying interventions for
deadoption (disinvestment)
Yes/No
No, such a mechanism does not exist
For the full set of scores, scoring guidelines and research methodology, please download the findings and methodology report, available here:
www.vbhcglobalassessment.eiu.com
© The Economist Intelligence Unit Limited 2016