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Deepening Health Reform in China Building High-Quality and Value-Based Service Delivery

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Deepening Health Reform in China Building High-Quality and Value-Based Service Delivery Deepening Health Reform In China Building High-Quality And Value-Based Service Delivery Policy Summary China Joint Study Partnership World Bank Group, World Health Organization, Ministry of Finance, National Health and Family Planning Commission, Ministry of Human Resources and Social Security 2016 Contents Foreword . ix Acknowledgements . xi Executive Summary . xv Abbreviations . xxv Introduction . xxvii Background: Impressive Gains in Health Outcomes, but Substantial Challenges Ahead 1 Aging, chronic disease, and risk factors . 2 Quality of care . 6 Inefficient service delivery: hospital-centrism, fragmentation and Distorted incentives . .. 6 Risk of low value care: Diminishing gains in health with escalating Health spending . 10 Spending projections . 11 Part I Service Delivery Levers 17 Shaping tiered health care delivery system in accordance with People-Centered Integrated Care Model (Lever 1) 19 Introduction . 19 Challenges . 23 DEEPENING HEALTH REFORM IN CHINA iii iv DEEPENING HEALTH REFORM IN CHINA Core action areas and corresponding implementation strategies for developing and implementing PCIC-based service delivery model: lessons from international and national experience . 24 Improving Quality of Care in Support of People-Centered Integrated Care (Lever 2) 35 Introduction . 35 Challenges to Improving Quality of Care in China . 36 Recommendations for Improving the Quality of Care . 40 Engaging Citizens in Support of the People-Centered Integrated Care Model (Lever 3) 49 Introduction . 49 Challenges to engaging citizens . 50 Recommendations: Strengthening Citizen Engagement . 51 Reforming Public Hospitals and Improving their Performance (Lever 4) 65 Introduction . 65 Challenges and lessons in Public Hospital Governance and Management in China . 66 Recommendations for moving forward with public hospital reform: Lessons from Chinese and international experience . 70 Part II Institutional and Financial Environment Levers 77 Realigning Incentives in Purchasing and Provider Payment (Lever 5) 79 Introduction . 79 Key Challenges in Purchasing Health Services and Paying Providers . 80 Recommendations for Realigning Incentives in the Health System in China . 82 Strengthening Health Workforce for People-Centered Integrated Care (Lever 6) 89 Introduction . 89 Key Challenges in the Human Resource Management in China . 90 CONTENTS v Recommendations for Moving Forward with Human Resources Reform: Lessons from Chinese and International Experience . 93 Strengthening Private Sector Engagement in Production and Delivery of Health Services (Lever 7) 97 Introduction . 97 Key Challenges . 99 Recommendations for Strengthening Private Sector Engagement in Production and Delivery of Health Services: Lessons from Chinese and International Experience . 102 Modernizing Health Service Planning to Guide Investment (Lever 8) 107 Introduction . 107 Key Capital Investment Challenges in the Health Sector in China . 108 Recommendations for Moving Forward with Service Planning Reform: Lessons from Chinese and International Experience . 110 Part III Moving Forward with Implementation 117 Strengthening Implementation of Service Delivery Reform 119 Introduction . 119 Implementation Challenges . 119 An Actionable Implementation Framework . 121 Moving Forward: Spreading Effective and Sustainable Implementation at the Local Level . 123 Toward a sequential reform implementation plan for reaching full scale in China . 132 Annexes . 135 Annex 1 Levers and Recommended Core Actions . 136 Annex 2 Government Policies In Support of the Eight Levers . 138 Annex 3 New Policy Guidelines on Tiered Service Delivery (Guo Ban Fa [2015] NO 70). and Recommended Core Actions . 142 Annex 4 Nomenclature and Summaries of 22 PCIC Performance Improvement Initiatives . 144 Annex 5 Impact Frequency of Studies on PCIC Initiatives (no . of studies) . 147 References . 149 vi DEEPENING HEALTH REFORM IN CHINA Boxes I 1. What is Value in Health Care? . xxviii I .2 Suggestions of the CPC Central Committee on the 13th Five-year Plan for National Economic and Social Development on the promotion of a “Healthy China” (pp . 42–43, English translation) . xxix I .3 Report Structure . xxxi I 4. Nomenclature, Name and Location for Commissioned Case Studies . xxxiv 2 1. Defining People-Centered Integrated Care . 20 2 1. Impacts of PCIC-like models . 21 2 1. The Potential Benefits of People-Centered Integrated Care . 22 3 1. What is Quality? Why Quality is important? . 37 3 .2 Existing evidence of over-utilization of drugs and health interventions . .39 3 .3 Core action areas and implementation strategies to improve healthcare quality . 40 4 1. Why is citizen engagement important? . 51 4 .2 Citizen Engagement to improve health care: core action areas and corresponding implementation strategies . 52 4 .3 Health Education in the UK: Skilled For Health . 54 4 4. Social marketing in China: Prevention and control of Hepatitis B . 55 4 .5 The Million Hearts Campaign . 56 4 .6 Encouraging self-management of health: Examples from the UK and India . 59 4 7. Improving patient involvement at the Beth Israel Deaconess Medical Center in the US . 60 4 .8 Decision Aid for Stable Coronary Heart Disease by the Informed Medical Decisions Foundation 4 .9 Health Coaching to Coordinate Care in Singapore . 61 4 10. Examples of using nudging and regulation to change target behaviors . 64 5 1. Management Practice Domains . 68 6 1. Examples of provider payment reforms in China . 85 9 1. Distinguishing Features of an Effective Service Planning Approach . 108 9 .2 Horizon’s Three Step Model . 111 9 .3 Physical Redesign of Northern Ireland’s Health System Model . .. 115 10 1. Government Administrative Reforms and International Experience . .. 127 Figures ES 1. 8-in-1 Interlinked Reform Levers . xviii ES .2 Reform Implementation Roadmap . xxiii 1 1. Share of the Elderly in China will Rapidly Catch up with the OECD . 2 1 .2 Prominence of NCDs in the Burden of Disease and Causes of Mortality . 3 1 .3 Management of Hypertension and Diabetes . 4 1 4. Smoking and Alcohol Consumption in China Compared to Other Nations . 5 1 .5 Hospital beds in China compared to OECD, 2000–2013 . 7 1 .6 Rapid Growth in the Number of Hospitals and Shift toward Higher Level Facilities . 7 1 7. Rising Health Care Cost in China . 11 1 .8 Health Care Expenditure Growth Rate in China . 13 1 .9 Composition of Health Spending in China, 1997–2013 . 14 1 10. Trend in Life Expectancy Compared to Total Spending on Health, 1995–2015 . 14 1 11. Diverse Paths to Better Health . .. 15 2 1. Illness Burden Scorecard to risk stratify patients . .. 26 CONTENTS vii 2 .2 Responsibilities of PACT team members . 27 2 .3 PACE Continual Feedback Loop . 33 5 1. Scores by Management Practice, China 2015 (n=110 hospitals) . 69 6 1. Composition of Total Health Expenditure in China, by facility or provider (percent) . 82 7 1. Health Workers Compensation across levels of Care and Providers, China 2013 . 91 8 1. Growth in Hospitals by Ownership . 98 8 .2 Growth in PHC Facilities by Ownership (2005 to 2012) . 98 8 .3 Growth of Hospital Admissions by Ownership, 2005–2012 (in 10,000) . 98 8 4. Growth of Outpatients Visits by Ownership, 2005–2012 (in 10,000) . 99 10 1. Proposed Oversight, Coordination and Management for Service delivery Reform Implementation and Scale-Up . 124 10 .2 The Transformation Learning Collaborative (TLC) model in three different arrangements . 129 Tables 1 1. Hypertension diagnosis, treatment and control (age 35–84): international comparison . 4 2 1. Core actions areas and implementation strategies to achieve PCIC . .. 24 5 1. Hospital Governance Models in Selected Countries . 73 8 1. Percent of Health Workers in Private Facilities by Type . 102 10 1. Examples of Policy Implementation Monitoring Guidelines for China’s Value-Driven Future . 125 10 .2 Examples of monitoring indicators by reform goal . 131 10 .3 Scoring System for Transformation Learning Collaboratives . 132 10 4. TLC Provincial Roll Out by Phase, Time Interval and Jurisdiction . 133 Foreword During the last three decades, there has take a huge toll on health, and non-commu- been a momentous social transformation in nicable diseases account for more than 80 China, with 600 million people pulled out of percent of 10 .3 million deaths every year . At poverty . At the same time, China has made the same time, with higher economic growth, impressive strides in health . Since the launch increased personal incomes, and fast changes of a new round of reforms in 2009, China in consumption patterns, people are demand- has invested substantially in expanding ing more and better health care . As a result of health infrastructure, achieved nearly uni- all these factors, expenditures on health care versal health insurance coverage, promoted have been increasing continuously . China is more equal access to public health services, facing greater challenge as the high growth and established a national essential medicine rates of health expenditure in the past years system . These measures have significantly may be difficult to sustain under the eco- improved the accessibility of health services, nomic slow-down . greatly reduced child and maternal mortal- The Chinese government fully recognizes ity, incidence of infectious disease, and con- the need to make strategic shifts in the health siderably improved health outcomes and life sector to adapt to these new challenges . expectancy of the Chinese population . Aver- President Xi Jinping and Premier Li Keqiang age life expectancy of the Chinese people have
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