Introduction of the Project on Utilising UK Expertise to Develop Evidence-based Care

Pathways for Chronic Disease in China thereby Opening Up Business Opportunities

for the UKProf. Kun Zhao

Qingdao, 28th July

Background

Goals

Content

Research team

Timeline

1

2

3

4

5

Outline

1. Background标题

中国人口结构变化趋势

60+60+

60+ 60+

1950 2005

2020 2050

导致过早死亡的主要原因, 1990 and 2013

生命损失年是由于早死导致生命损失的年份. Rankings based n YLLs per 100,000, all ages, not age-standardisedSource: GBD 2013

中国慢病负担

• 2012年慢病死亡率: 533/10万，占总死亡率的86.6%；

• 心血管疾病、癌症和慢性呼吸系统疾病是主要的致死疾病（79.4%）

• 15岁以上高血压人群：2.7亿

• II型糖尿病 : 831.6万

Flowchart of patient seeking for doctors

疑难杂症Tertiary

hospital

Secondary

hospital

Primary

healthcare

facilities

Community healthcare

center/station, township

healthcare center

Tertiary hospital

County level hospital

Bed usage rate in China, 2013

Hospital Usage rate（%）

Tertiary 102.9

Secondary 89.5

Primary 60.9

全国卫生总费用及增长速度

0

5

10

15

20

25

1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

%

国内生产总值增长速度 Growth rate of GDP 卫生总费用增长速度 Growth rate of TEH

0.0

1.0

2.0

3.0

4.0

5.0

6.0

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

22000

24000

26000

28000

30000

32000

34000

36000

38000

1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

%亿元（ 100million RMB）

卫生总费用 TEH 卫生总费用相对于GDP% TEH as % of GDP

0 20 40 60 80 100

2014

2013

2012

2011

2010

2009

2008

2007

2006

2005

2004

2003

2002

2001

2000

1999

1998

1997

1996

1995

广义政府卫生支出占卫生总费用% General government expenditure on health as % of TEH

私人卫生支出占卫生总费用% Private expenditure on health as % of TEH

Policy background—No.70 (2015), issued by the State Council of PRC

Guidance on Implementing Tiered Healthcare System in China

• Select hypertension, diabetes, cancer and cardiovascular diseases•Implement tiered healthcare system based on the selected diseases

21%

Complicated conditions

Chronic diseases

21%Complicated conditions

Chronic diseases

48%

Chronic disease

prevention

10%

Complicates syndromes

Emergent/severe

Chronic, long-term, normal diseases

Recovery phase of severe diseases

Long-term healthcare

Palliative care

Health promotion, check-ups, screening,

management of chronic diseases patients

“triage”

Resource allocation reform

Tiered healthcare system reform in China

90%

Tertiary

Secondary

Primary

新医疗技术助力健康中国2030-----实现UHC 和 SDG

指标 中国 排名 发达国家均数

预期寿命 75.5 72 74.3

THE/GDP 5.6 123 5.8

人均卫生总费用(US$) 375.79 97 408.00

人均GDP(US$) 6991.9 93 7719.6

• 花费额外的费用得到额外的收益

Fixed budget(and reduction) VS competitive health

technology

Over and under-healthcare

Antibiotics accounts for42%，

hormorn15%，vitamins69%

---from a 6000 prescriptions survey

The amount of IV injection in China

was 10.4 billion, 8 for every patient,

which is a lot higher than the

average number around the world

(2.2-3.5)

----from Chinese NDRC

Lack of nursery care, especially for

chronic diseases

15

effective13%

possiblely effective22%

effective equals to harm 8%

无效6%

harmful3%

uncertian effectiveness

48%

数据来源: BMJ, 2007 in Alan Maynard, “Payment for Performance (P4P): International experience and a cautionary proposal for Estonia”, Health Financing Policy Paper, Division of Country Health Systems, WHO, 2008. P. 6.

Uncertainty of clinical effectiveness

Uncertainty of clinical effectiveness

疾病诊治和管理指南及质量标准

临床试验及

证据评审

临床指南及

卫生技术评估

质量标准

• 医疗教育和职业培训

• 绩效管理• 预算管理

• 服务提供方支付机制，包括按病种付费

• 同患者及其家属沟通的责任

• 临床审计和服务方基准

• 服务方规范和评审

17

Current situation in China—Chinese acute TIA guideline, 2014

Comments from Tony, UK

2. UK-China collaboration project标题

Promote evidence-based decision-making

Enhance the management of chronic diseases

Implement tiered healthcare system plan

International guidance on the development of clinical guidelines

Features：Legislation-based, evidence-based, transparent, public, scientific

Organizations：WHO, NICE, SIGN, AHRQ, Australia institute

Framwork of international guidance

Comparison between Chinese and British Guidelines

3. Content标题

Working mechanism

UK embassy

Qingdao pilot

Xiamen pilot

CNHDRCNICE

international

Capita

Founder

Development of SAPOrganization and coordination

International expertise

IT support

Expert teamSite visit

Main activities

• Based on international standards

• Localized

• Hypertension, diabetes

Standardized approaches and

procedures

• Based on NICE text

• Linked with IT system

• Hypertension, diabetes

• Develop quality standard indicator

Manual for quality standard • Chronic disease

management system in Qingdao and Xiamen

• Evaluation of the systems

• Identify issues

• Support decision-making

Evaluation

Evidence-based standardized approaches and procedures (SAP)

•NICE international

•Domestic experts

•CNHDRC

• MoH , Qingdao, Xiamen health bureau

• NICE international

• CNHDRC

• Qingdao, Xiamen Health Bureau

• Related pilot hospitals

• Central experts

• NICE international

• CNHDRC

• International framework

• NICE international

• Experts

• CNHDRCFirst draft of

SAPPilot

implementation

Hypertension

DiabetesFinalize SAP

Evidence components of SAP

•Clinical effectiveness

•Cost-effectiveness

•Budget impact

•Ethical issue, equity

Manual for quality standard

Based on NICE’s experiences, localize

Test in pilots, develop quality standard indicators for hypertension and diabetes

Review and revise

Finalize the manual

Evaluation of chronic disease management system

Baseline survey

• Qingdao system

• Xiamen system

Produce evaluation system

• Define the framework

• Identify evaluation indicators

Evaluate systems

• Based on the evaluation system

• Data collection and analysis

Write evaluation

reports and policy briefs

4. Research team

Research team

NHFPC UK embassy

NICE international

Xiamen Health Bureau

Qingdao Health Bureau

CNHDRC

Pilot healthcare institutions

Capita

5. Timeline标题

Monitor and site visit

Pre-survey

Launch meeting

6月 9月 10月 1月7月 8月 11月 12月

2016 2017

Timeline

2月 3月

First draft of

SAP and manual

Review and revise

Update existing guidelines

Create indicators

Finalize

Conclusion