The grant, which will cover five years, represents a significant uplift to the funding granted to iDSI in 2015 and will allow us to continue working relationships with policymakers and healthcare payers to understand and respond to the challenges they face – whether ensuring the financial sustainability of a health insurance fund or fair access to good quality care across public health facilities.

This next phase of iDSI will see stronger emphasis on Sub-Saharan Africa with iDSI’s flagship countries including Kenya and Ghana, where global health funders will be departing and domestic health care spending is on the rise. Additionally, many Sub-Saharan African countries are currently introducing national health insurance or coverage plans and making important decisions about what health services and technologies should be included in Universal Health Coverage (UHC) offerings, where value for money considerations could make a huge difference in health outcomes.

As a result of the renewed funding, iDSI’s global network of expertise is expanding – we’re pleased to report iDSI core partners now include: the Asia Health Technology Assessment consortium which includes the National Health Foundation of Thailand, the Saw Swee Hock School of Public Health, National University of Singapore and Health Intervention and Technology Assessment Program; the Health Economics Research Unit of the KEMRI Wellcome Trust Programme, the Norwegian Institute of Public Health and the Clinton Health Access Initiative, Inc.,in addition to current core partners: the Global Health and Development Group at Imperial College London, the China National Health Development Research Center and the Center for Global Development.

The network endeavours to generate long-term, locally-owned solutions to health care challenges through building capacities for using evidence in policy and clinical decisions. Its impact to date includes influencing policy in eight countries – China, India, Indonesia, Philippines, Vietnam, South Africa, Tanzania, and Ghana – where there has been tangible progress toward national institutions being established to embed value-for-money into decision-making about what medicines, vaccines or other health services should be offered to the population, and how these could be procured in the most cost-effective way. Already iDSI has supported Tanzania to prioritise its Essential Medicines List from 500 to 400 drugs, reducing spending on poor value items and freeing up resources to improve access to the most cost-effective medicines, trained Kenya’s Health Benefits Package Committee on measuring the added value of a new health intervention compared to existing ones, piloted a local quality improvement initiative with hospital staff in Vietnam to reduce inappropriate antibiotic prescribing for pneumonia and brought together more than 100 policy makers, academics and industry representatives working across Sub-Saharan Africa for a special event to share knowledge and best practices.

iDSI Director Kalipso Chalkidou, a Professor of Global Health Practice at Imperial College London who also directs the Global Health program at the Center for Global Development, said: “With government and aid budgets under pressure, many developing countries are facing declines in health funding and are going to have to make difficult choices. Policymakers’ decisions about what health care to make available and at what cost can be a life or death decision for people across the developing world. We will inform these critical decisions with data and evidence that maps out how best to spend limited funds to improve outcomes and save lives.”

Chinese, Thai, Norwegian, and British governments have backed iDSI, which also receives funding from the Department for International Development, the UK government department responsible for administering overseas aid.

Amanda Glassman, Chief Operating Officer at the Center for Global Development, said: “Previous health care decision making in developing countries has too often been driven by inertia and lobbying rather than science, economics, ethics and the public interest. We want to change that.”

Ira C. Magaziner, Chief Executive Officer of the Clinton Health Access Initiative Inc (CHAI), said: “Low- and middle-income countries are set to make great strides toward universal health coverage in the coming years, ensuring that all people have access to affordable and quality care. CHAI works with governments that are implementing health financing and service delivery reforms to meet this goal. We are excited to deepen our collaboration with the iDSI network to help partner governments set health care priorities, drawing on iDSI’s expertise and years of experience across different country settings.”

Trygve Ottersen, Executive Director at the Norwegian Institute of Public Health, said: “Without proper support, it is hard for decision-makers to navigate within the broad and ambitious agenda of the Sustainable Development Goals and to make evidence-informed choices that are both fair and efficient. iDSI serves as a unique platform for supporting the most critical choices on the path to UHC and the Institute is delighted to be part of this partnership.”

Professor Teo Yik Ying, Dean of the Saw Swee Hock School of Public Health at the National University of Singapore, said: “The Saw Swee Hock School of Public Health at the National University of Singapore is delighted to be a contributing partner to iDSI. The mission of iDSI to support evidence-based decision making in global public health is aligned to the mission of the School, with the aim of translating research discoveries to improve the health of global communities.”

Dr Somsak Chunharas, from the National Health Foundation of Thailand, said: “Being an organisation promoting evidence-based policy and system development in Thailand for the last 30 years, the National Health Foundation looks forward to this opportunity to share and learn from various countries’ context in establishing the mechanism and tools for evidence-informed policy.”

iDSI was borne out of the recommendations of the Center for Global Development’s Priority-Setting Institutions for Global Health Working Group in 2012.

The 22 delegates, from both clinical and non-clinical backgrounds, visited London and Cambridge to develop their understanding of the UK healthcare system, including health-related legislation and regulatory mechanisms, policy development and health reforms.

Along with visits to St Thomas’ Hospital, Boots Pharmacy’s corporate office and AstraZeneca, the group received talks on the role and function of National Institute for Health and Care Excellence and the Medicines and Healthcare Products Regulatory Agency in protecting and improving public health; the pricing of branded and generic pharmaceuticals in the UK; vaccine evaluation; the development of evidence-based clinical pathways and integrated care pathways; and how to best to make use of electronic health record systems.

Members of the delegation from China with iDSI staff in Queen’s Gate

Yu Ou’yang from the Division of Medical Administration within the Hunan Provincial Health Commission in China said: “Over the last two weeks we have had presentations from almost 30 experts, even though the context of the UK and China is very different there has been so much for us to learn here. During the study tour I have realised healthcare management and delivery in the UK is very detailed and precise to ensure all goes as smoothly as possible, the UK also takes into account the balance between cost and effectiveness in healthcare which is extremely important. It has been great to learn more about standardised operations such as Clinical Commissioning Groups and NICE and their responsibilities. I would like to extend my thanks to all the presenters and those that facilitated our practical days.”

Ying Peng, who is based in Beijing but also carrying out a PhD in Health Economics at the University of Sheffield, said: “The range of presentations we received will really help my own PhD studies, I’ve definitely developed my understanding of how new interventions are appraised in the UK and how evidence is the pinnacle of decision-making. It was really important for me to learn more about the UK health system, which organisations underpin it and how this could be adapted for China.”

The group was made up of officials from iDSI core partner the China National Health and Development Research Center (CNHDRC) and the Chinese Ministry of Health (National Health Commission); along with policy makers and academics from Huazong, Beijing and Shanghai universities.

Liu Jianan, from the Division of the Essential Medicines List, within China’s National Health Commission, said: “Our delegation is diverse but between us all we have rich experience and knowledge. Our learning over the last two weeks has been delivered in such a systematic way; there is still much more we can learn from the UK healthcare system however for now I am pleased we will all be able to bring back our experiences from this trip, especially for matters such as pricing for medicines, which is of broad and current interest in China.”

Chen Bo, a PhD student from Peking University’s School of Public Health, said: “I feel very lucky to be here. The talks have inspired me a lot, particularly as my current area of study is public hospital reform at county-level in China. For me the most valuable part of the study tour has been expanding my knowledge of the ways in which hospital reforms could be made more efficient; and learning so much about Cost Effective Analysis exercises and ways we could push forward with this in China.”

Francis Ruiz, iDSI Senior Advisor, said: “The Global Health & Development Team at Imperial and iDSI have been delighted to organise study tours to the UK for senior Chinese officials since 2014. The talks from various presenters, including representatives from The Nuffield Trust, NHS England, NHS Benchmarking and feedback on their own workstreams from the delegates themselves has been a fantastic complement to off-site days where the group observed the delivery of health care first-hand and attended a workshop focused on primary care. We hope the visit was valuable and will have positive impact on them as individuals; and help develop the UK-China partnership in Health Technology Assessment.”

The first day started with the dissemination meeting of a project supported by the UK Prosperity Fund. The project, led by CNHDRC, focused on utilising UK expertise to support the development of standardised methods to generate evidence-based care pathways for chronic disease in China. The division director of CNHDRC, Prof Kun Zhao, outlines the aim of developing a standardized approach to developing and updating clinical guidelines in China, with a practical application to existing care pathways and guidelines in hypertension and diabetes, currently in use in Xiamen and Qingdao.

The meeting continued with an overview by experts from Xiamen and Qingdao on the ongoing efforts to improve the management of patients with chronic diseases. At the end of the meeting Prof Mike Roberts from UCL Partners shared some experiences on transforming health care towards evidence-based practices and current thinking on new integrated care models in the UK. He emphasized the importance of establishing standardised guidelines to provide high quality and equitable care for the whole Chinese population.

During the afternoon of the 17th, a leadership training workshop was delivered. At the beginning of the workshop, participants were familiarized by the theory on how to implement change and introduce new guidelines into clinical practice.  Later on, effective team leadership strategies in implementing change were discussed.  The training was attended by senior officials from Xiamen Health Bureau and Qingdao Health Bureau, representatives from tertiary and secondary hospitals, nurses, local administrative officials as well as clinicians. The knowledge gained from the workshop is expected to help local stakeholders build effective clinical teams to implement the new guidelines in an efficient manner.

The following week, a workshop was held over two days on ‘Health Policy Evaluation and Technology Assessment Knowledge Sharing’. This workshop was organised in order to help support the momentum generated by the newly launched China Health Policy and Technology Assessment Network, with CNHDRC in the role of focal point of the network (the iDSI China HTA hub).  The workshop was opened by Hongwei Yang, the deputy Director General of CNHDRC, Prof Kun Zhao and Dr Kalipso Chalkidou, Director of the GHD. The aims, objectives and structure of the nascent China HTA network were introduced. In addition, the workshop explored a number of topics considered highly relevant for HTA development in China. These include the role of the iDSI Reference Case and how it may be adapted for a Chinese context; evaluating non-budgetary constraints; health system strengthening; measuring HTA impact; economic evaluation and public health; adapting HTAs; and HTA and medical devices.  For each thematic area there were presentations from UK-based academics and Chinese researchers, as well as experts from the Thai HTA agency, HITAP. HITAP colleagues shared their experiences of how HTA was used to inform UHC policy in Thailand. The workshop concluded with reflections on the working plan for the China network as an iDSI HTA hub, and exploring new collaborations and next steps.

In terms of next steps, it was highlighted that a key objective should be to increase the number of members of the China Health Policy and Technology Assessment Network and on standardising the methodology used in developing clinical guidelines, especially for chronic diseases in China.

1- Dissemination Meeting on Developing Evidence-based Care Pathways for Chronic Disease in China
February 17th – Morning

National Developments showcase & providing means for utilising UK expertise

Following successful launch of this UK supported Prosperity Fund project on July 28th 2016, the dissemination meeting had the key aim of communicating progress in establishing a standardised approach to clinical guidelines development, and in applying them to update existing care pathways in China. The topic areas selected for the pilot were on priority chronic disease areas namely hypertension and diabetes that were currently in use in Xiamen and Qingdao cities.

A representative on the behalf of CNHDRC Director General- Ms Wei Fu gave an opening speech where he provided an overview of the burden of chronic diseases in China. He described China’s aging population as a critical high priority issue, highlighting the estimated 220 million people aged above 60 in China, added to by about 8 million people per year. He emphasized the significance of establishing a ‘tiered healthcare system’ in China utilizing UK NHS expertise and experience to support the local development of standardised care pathways. He concluded by inviting the audience of about 50 in number consisting of senior officials from Xiamen Health and Qingdao Health authorities, representatives from tertiary and secondary hospitals, nurses, local administrative officials and clinicians- to share the results of the preliminary version of the guidelines handbook, and encouraged feedback and discussion among attendees.

Ashwini Kirchner, Head of Health and Social Care at the British Embassy in Beijing highlighted the importance of bilateral commitment between the UK and China, to learn from one another. She stated that healthcare is a key point of interest between the two countries. Kirchner highlighted the aims of Prosperity Fund Project in providing cutting edge policy in an area where the UK can offer expertise, and to give way for a real impact on the ground.

Kun Zhao, Division Director in CNHDRC, described the status quo and progress of Chinese guidelines development. She compared UK and Chinese guidelines, and provided recommendations for realizing the project aims. She linked the importance of robust guidelines development with the considerable uncertainty around the effectiveness of most of new technologies in China, and the absence of economic and equity perspective in setting hospital treatment standards in different regions in China.

The preliminary version of the Chinese guidelines handbook received strong positive feedback from the audience. Changqin Liu, Vice President of the first affiliated hospital of Xiamen University noted the professionalism underpinning the handbook and described it as a first of its kind to be developed in China.

“This guidelines handbook is very comprehensive…It is first time where we can align with UK Clinical Guidelines principles….I learned a lot”
Fusong Liu- Cardiology department Director of The Third People’s hospital of Qingdao.

Professor Mike Roberts of UCL Partners concluded the meeting by giving a brief presentation on new models of care in the UK, such as ‘Integrated Care Pioneers’ and ‘Vanguard sites’. His presentation can be found here.

2- Leadership & Change Management training
February 17th – Afternoon

Leading Change: New guidelines, new approach..

The afternoon session was dedicated to a training workshop that builds on the introduction of the new guidelines in Xiamen and Qingdao hospitals. According to Mike Roberts, the implementation of new guidelines depends on a number of factors, the most important of which are understanding and managing the change process involved, and developing effective leadership among the interdisciplinary teams adopting the new hypertension and diabetes clinical guidelines.

The training workshop took place over 3 hours and involved presentations on change management by Reetan Patel, effective team leadership by Mike Roberts, combined with an interactive discussion and group work scenarios. The group work emphasised the experience of trying to implement a new set of clinical guidelines and how they may be understood from different perspectives among the stakeholders affected such as management, clinicians and other various implementing teams. The audience were mainly senior officials from Xiamen and Qingdao health authorities, representatives from tertiary and secondary hospitals, nurses, local administrative officials and clinicians.

3- iDSI HTA workshop: knowledge sharing event to support newly launched China HTA network
February 20th – 21st

The role of HTA in international development & National Regulatory Authority strengthening

The iDSI HTA workshop in Xiamen builds on the MOU supporting informed implementation framework for HTA between GHD and CNHDRC. The two-day workshop revolved around 6 main themes: standardised methods for economic evaluation, non-budget constraints and health system strengthening, measuring HTA impact and return on investment, HTA and medical devices, economic evaluation modelling and public health, and adapting HTA to the Chinese context.

The workshop commenced with an opening statement by a representative of CNHDRC on the behalf of Deputy Director Hongwei Yang, who emphasized that the current leadership in China is very supportive of HTA capacity building especially in light of major technology transformation in China.

Kalipso Chalkidou gave an overview of the objectives of the HTA workshop including outlining the role of iDSI HTA hubs for supporting national and regional HTA related activities. Kun Zhao introduced the China HTA network, which is a network of 29 institutions and hospitals backed with a great amount of support by the Chinese healthcare authorities (the presentation can be found here). Tony Culyer briefly introduced the iDSI Reference Case, what it is and how it can be adapted to China context (see his presentation here).

Professor Pete Smith of Imperial College London delivered a presentation on developing a framework for evaluating interventions aimed at health system strengthening. Eleanor Grieve of University of Glasgow talked about developing a theoretical framework for assessing the impact of HTA and the return on investment. Professor Klim McPherson of Oxford University provided a presentation on role of epidemiological modelling to support decisions in public health, and Anastasia Chalkidou and Naomi Herz of KiTEC talked about assessing medical devices and the challenge of incorporating economic evaluations in that field (their presentations can be found here).

Chinese academics linked with the new HTA network also spoke about the role of HTA in China in line with the themes of the workshop. There were presentations on: Standards and procedures of HTA in China by Haiyin Wang, Division Director of Shanghai Health Development Research Center, Performance evaluation on public health system in China by Professor Zhachun of Tongji University, Outcome Evaluation of the Tiered healthcare system in China by Rui Zhao of CNHDRC, Rapid HTA on Proton and Heavy Ion radiotherapy by Michelle Li of CNHDRC; Economic Evaluation of hepatitis B management strategy in China by Steven Qiu of CNHDRC; and finally, a talk by Jenny Sui of CNHDRC on using international evidence to assess cellular immunotherapy.

The iDSI HTA workshop provided an opportunity for new collaborations between Chinese HTA specialists, UK researchers, and colleagues from neighbouring countries. During the second day of the workshop, a roundtable discussion involving health officials and academics from Indonesia, Cambodia and China highlighted the interest in engaging in mutual cooperation, and the opportunity offered by the Chinese HTA network in providing regional support. The rise of China’s HTA capacity comes at a pivotal timing given the upcoming BRICS Summit scheduled to take place in Xiamen next September. The five key priority areas for BRICS collaboration are: deepening cooperation, strengthening global governance, making institutional improvements and building broader partnerships. Within this context, HTA capacity buidling and wider heathcare refirm offers one important route to achieve these aims. The Goa declaration highlights the importance of BRICS cooperation in the area of healthcare regulation.

“We will seek to identify possibilities for cooperation among our health and/or regulatory authorities, with a view to share best practices and discuss challenges, as well as identifying potential areas for convergence”
8^th BRICS Summit- Goa Declaration October 2016.

China’s role in international support has been given added impetus by a number of initiatives including the recent “One Belt One Road” strategy. Such initiatives can provide important opportunities for sustainable development in countries along the Silk Road Economic Belt, and will be crucial in supporting the spread of evidence informed healthcare decision making in LMICs, a key objective of iDSI.

The main aim of the visit was the signing a Memorandum of Understanding (MoU) between the China National Health and Development Research Center (CNHDRC) and the Institute for Global Health Innovations (IGHI). This agreement is the first collaboration between Imperial College and CNHDRC.

Find a more detailed visit report on the IGHI webpage 

The slides can be found here

The Prosperity Fund is one element of the UK’s total overseas development commitment, and in China it is focussed on promoting economic reform and growth while supporting the delivery of China’s 13th Five Year Plan (2016-20).

At the official launch meeting there were opening speeches by Wei Fu (Deputy Director of CNHDRC) and Rachel Ainley (Senior Policy Officer, Health and Social Care, British Embassy) to an audience of over 40 people, including representatives from the National Health and Family Planning Commission (NHFPC) and the British Embassy in Beijing. Representatives from Huangdao and Xiamen – the two pilot sites in the project – described their experiences to date in improving the management of patients with chronic diseases such as diabetes and hypertension, with an emphasis on using IT systems to support integration between hospitals and community health centres, and in developing criteria for patient referral and outcome assessment. Deputy Director General Wei, which can be found here,  and Deputy Director General Hong, which can be found here, of the Health and Family Planning Commission of Qingdao and Xiamen respectively, set out the strategy and aims of their integrated care initiatives in the pilot areas including the objective of reducing unnecessary hospitalisation, presenting some initial findings where quality and efficiency have improved.

Prof Kun Zhao of the CHNDRC provided background to the project, noting that a key aim of this work is to develop a standardised approach to developing clinical guidelines and any derived quality measures in China, and applying it to existing care pathways and guidelines on hypertension and diabetes currently in use in Xiamen and Qingdao. Her presentation can be found here. Francis Ruiz from GHD, presented on international experience in explicit priority setting and health technology assessment, stressing how HTAs and clinical guidelines can be used to improve frontline practice through the development of targeted quality measures linked when appropriate to financial incentives. His presentation is here.

The launch concluded with a presentation from Dr Charles Young, Chief Medical Officer of Capita Healthcare Decisions, who along with GHD are involved in the activities associated with this Prosperity Fund project. Dr Young described Capita’s work in decision management, particularly their expertise in nurse-led telephone triage and clinical record management. Implementation of Capita’s decision support system has contributed to reduced primary care referrals and savings of over £213 million to the UK NHS. The previous day Capita delivered a detailed workshop on their decision management system including a demonstration of their software to an audience of policy makers, clinical professionals and IT specialists. This highlighted the potential benefits of clinical IT systems linked with algorithms based on evidence of best practice, to effectively triage patients and support better referral decisions. Attendees at this workshop included representation from Ping An Health Insurance, who also provided support for the event. They have a strong interest in the role of clinical guidelines and decision support tools in supporting the services they provide both within and outside China. Chinese coverage of this event can be found here.

The purpose of the project was to introduce clinical pathways for chronic obstructive pulmonary disease (COPD) and stroke. The pathways cover prevention, treatment and rehabilitation guidance for clinicians at different levels of healthcare delivery.

Domestic and international experts discussed the early findings from the project and their relevance to other areas of clinical practice and policy. These findings are available in a report by the CNHDRC which describes the design and progress of the project. Full appendices for the report are also available here: (1), (2), (3), (4), (5).

The clinical pathways

The clinical pathways were developed with Chinese and international clinical input and were part of a varied intervention including:

• multi-stakeholder engagement,
• changes to IT infrastructure and
• performance management strategy within the pilot hospitals and capacity building activities.

The most recent phase of the pathway (2012 onwards), supported efforts to improve the integration of care across multiple levels of the rural health system in China. It emphasised pathways for non-communicable disease (stroke and COPD).

The intervention was designed to address concerns that inappropriate behaviour by providers, such as overuse of antibiotics and intravenous delivery of medication against clinical evidence, has fuelled cost growth and affected quality of care and patient safety.

The misuse of resources may in part be due to an absence of practical clinical guidelines and effective monitoring mechanisms for use of medicine and medical devices. This is especially concerning for non-communicable diseases (NCDs), which account for an estimated 87% of annual deaths and 69% of the total disease burden in China. NCDs are expected to account for an increasing share of health expenditure.

illustration of the COPD clinical care pathway

illustration of the stroke clinical care pathway

Early findings

The project launched in four pilot counties in November 2013. By May 2015, 5,490 patients had been managed by the clinical pathways. This figure represents 90% of those who entered the pathways (some had to leave the pathways, for example after developing unusual complications) and 54% of all eligible inpatients.

860 COPD patients also received free pneumococcal vaccines, experiencing reductions in acute exacerbations of their COPD and stays in hospital.

The project also built capacity for rehabilitation services, with each pilot site establishing locally-developed, integrated rehabilitation networks.

A year after the launch of the project, analysis of routine clinical data in the pilot sites suggests that:

• The intervention is associated with greater use of those services recommended in the clinical pathway.
• Services with the most significant increase in usage were statins and brain imaging (within 24 hours of hospitalisation) for stroke treatment.
• There was a reduction in the growth of resource use, and reduced average lengths of inpatient stay, in the four pilot sites.
• The proportion of out-of-pocket (OOP) expenses also decreased.

The findings of this early analysis are discussed in more detail in the full report.

A ‘revolutionary’ impact

The most striking outcome of this project is the increased willingness among clinicians and policymakers to use evidence. This has led to broader changes in how clinical care is delivered, which was highlighted in a report by Itad on our engagement in China

At the management level, Huangdao People’s Hospital described the training they had received as ‘revolutionary’, stating that it changed the way they think about treatment.

According to one senior interviewee, clinicians who had previously based treatment on their own experience were now basing treatment on evidence.

Stakeholders also indicated that the implementation of clinical pathways is changing doctor-patient relations. Clinical staff reported improvements in communication with patients and patients’ understanding of their care. This had increased transparency and patient adherence to treatment.

Representatives from Qianjiang also noted the great value of the project in building managerial capacity and teaching healthcare providers to establish mechanisms for collaboration and referral across different tiers of the health system.

A separate report from Itad highlights the impact of the pathways:

Areas for future work

At the event in Beijing, Chinese physicians commented on how development of the pathways involved joint learning, with contributions from national and international experts valued. Areas for future improvement were also discussed, including how to further discourage non-evidence-based interventions often demanded by patients and improving national data coordination and analysis.

International representatives at the event were struck by the technical and political achievements and buy-in achieved by the project across all pilot sites.  Local implementers and policy-makers also emphasized the change in attitudes and greater understanding of the principles of evidence-based medicine. This is improving as clinical pathway reforms are rolled out in each district for up to 60 additional conditions.

The CNHDRC-NICE model of integrated care pathway development was specifically recommended by NHFPC to be scaled up as part of these reforms.

To help secure cost control and financial protection for patients it will be important to maintain a focus on payment reform. This will require a move away from the dominant ‘fee-for-service’ model, towards further case payments implemented as part of this project.

CNHDRC has the local demand and ability to become a hub for health technology assessment and evidence-informed priority-setting within the decentralised Chinese health system, and to support countries in the region as part of China’s developmental technical assistance.

The dissemination event (translated page) included representatives from the:

• National Health and Family Planning Commission (NHFPC)
• UK Foreign and Commonwealth Office
• Ministry of Human Resources and Social Security
• National Development and Reform Commission
• Ministry of Commerce
• Ministry of Finance
• Municipalities and healthcare institutions involved in the pilots
• and the International Decision Support Initiative (iDSI)

NICE signs MOU with CNHDRC during UK-China health talks

September 2015

NICE International holds final discussions with CNHDRC ahead of Clinical Pathways dissemination event in October

NICE International visit China with Indian colleagues

Qingdao Health Bureau and NICE sign a Memorandum of Understanding

Pilot project in China

The China National Health Development and Research Centre (CNHDRC) in collaboration with NICE International have embarked on a pilot project involving the design and implementation of evidence informed pathways of care, linked with payment reform with an emphasis on integrated care, for two high priority disease areas (chronic obstructive pulmonary disease [COPD] and stroke). This builds on the initial (Phase I) ‘Clinical Pathways’ (CP) project associated with the Health XI initiative and initiated in 2009, with WB, DFID China an DFID UK support.

The Chairman of NICE and the Director of NICE International spent a few days in Beijing meeting with NICE’s major partners in China and publicising NICE’s work in the rural health reforms.

September 2013

The meetings included a day-long meeting at Renmin University, the fifth annual bilateral conference between NICE and Renmin, which, this year, was focused on care quality, hospital reform and the role of integrated care, including primary care. The conference, hosted by Renmin, one of the most prestigious and oldest universities in China, with a track record in social sciences and health policy in particular, was attended by over 100 colleagues from across China, including the Beijing and Shanghai Health Bureaus, the newly formed National Health and Family Planning Commission (NHFPC), the Ministry of Human Resources and Social Security, as well as officials from the provinces, academics and hospital administrators. We look forward to continuing and intensifying our partnership with Renmin in the coming year.

On the second day of our visit we met with senior officials from the World Bank and with our long-term partners in China, the think tank of the ministry of health, the China National Health and Development Research Centre (CNHDRC). We discussed progress with implementation of our NCD clinical pathways across four rural pilot counties and plans for scaling the pilots up.

On day three we had the honour of meeting, together with CNHDRC, the Director General of Planning and Information, a new division at the NHFPC, with her colleagues, including the officer leading on the design of the 13^th 5-year strategic Plan and the Head of international affairs for Europe and North America. All three sides reiterated their commitment to working together, emphasising the need to improve efficient resource allocation at the micro/technology and macro/service delivery levels, and the importance of good quality community/primary care as the only means of achieving sustainable universal coverage.

This meeting was followed by a high level session with Vice Minister Ma where the Vice Minister called for NICE to continue and intensify its involvement in the Chinese health reforms, incl. urban health reforms, public hospital reforms incl. referral pathways and integration between prevention and treatment, and low and high tier hospitals. The Minister called for a strategic partnership between NICE, the Ministry and CNHDRC for institutionalising a Chinese model of Health Technology Assessment to meet China’s needs.

The second half of the day was spent at the Development Research Commission, the prestigious think-tank of the State Council, the Chinese equivalent of the Cabinet Office. The session was attended by colleagues from the National Development and Reform Commission, the NHFPC and different DRC divisions, and was supported by the British Embassy in Beijing. NICE offered to work with DRC in their research on HTA and quality standards and how these notions relate to the ongoing Chinese health reforms.

Clinical pathways and payment reform project launched in China

In this latest part of the project, NI engaged in a series of activities, with the aim of informing CNHDRC and MoH’s evaluation of the Clinical Pathways (CP) project, particularly with regards to its impact on costs and also to its potential for saving costs without compromising outcomes, in the longer run, should it be rolled out across rural China county hospitals.

NI provided hands-on advice and support – as well as offering advice on areas for improvement – to the Chinese teams in 2 areas:

1. Costing and budget impact analysis support and training: The NI team worked closely with CNHDRC to support the field-work, in particular in relation to the types of costing data required to undertake full costing analyses at the end of the early stage of the evaluation.

2. Clinical feedback on CPs: During their stay in Beijing and their field trip to QianJian and Hanbin, the team had the opportunity to discuss the challenges and opportunities of implementing CPs in the pilot provinces, from the perspectives of the doctors’ and nurses’ working in the rural hospitals and also from the perspective of the Beijing tertiary hospital experts. The team also had the chance to observe clinicians as they delivered care, talk to the hospital administrators and local health authorities and also the IT and billing teams in the hospitals.

A full report has been submitted to CNHDRC and MoH for consideration and to inform the ongoing reforms. It was noted that the CP pilot is an exciting and highly ambitious project that, if successfully implemented, has the potential to drive significant quality and efficiency improvements across rural China.