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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
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
China & asia health systems   Prof. Dr. Chang liu
• 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
The Regional Challenges in
Health Systems
Rapid aging
Stressed systems
Funding gap
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
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
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
China & asia health systems   Prof. Dr. Chang liu
The Regional Challenges in
Health Systems
Rapid aging
Stressed systems
Funding gap
04
6AM at a public hospital
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
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
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
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
健康体系的全球性挑战
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
The Regional Challenges in
Health Systems
Rapid aging
Stressed systems
Funding gap
05
健康体系的全球性挑战
• 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
Health Systems Transformation
Keywords:
Connected & integrated
People-centered
High quality
Value-based
Affordable
Sustainable
Trend 1 System transformation: towards more patient centered/ integrated care
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
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
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
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
• 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
26
Trend 2 Disruptions with new technologies and digital solutions
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
Source: Goldman Sachs Global Investment Research
Trend 2 Disruptions with new technologies and digital solutions
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
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
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
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
…
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
• 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
• “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
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
“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
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
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
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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China & asia health systems Prof. Dr. Chang liu

  • 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. 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
  • 4. • 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
  • 5. The Regional Challenges in Health Systems Rapid aging Stressed systems Funding gap
  • 6. 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
  • 7. 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
  • 8. 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
  • 10. The Regional Challenges in Health Systems Rapid aging Stressed systems Funding gap 04 6AM at a public hospital
  • 11. 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
  • 12. 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
  • 13. 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
  • 14. 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
  • 16. 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
  • 17. The Regional Challenges in Health Systems Rapid aging Stressed systems Funding gap 05
  • 19. • 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
  • 20. Health Systems Transformation Keywords: Connected & integrated People-centered High quality Value-based Affordable Sustainable Trend 1 System transformation: towards more patient centered/ integrated care
  • 21. 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
  • 22. 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
  • 23. 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
  • 24. 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
  • 25. • 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
  • 26. 26 Trend 2 Disruptions with new technologies and digital solutions
  • 27. 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
  • 28. Source: Goldman Sachs Global Investment Research Trend 2 Disruptions with new technologies and digital solutions
  • 29. 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
  • 30. 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
  • 31. 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
  • 32. 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 …
  • 33. 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
  • 34. • 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
  • 35. • “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
  • 36. 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
  • 37. “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
  • 38. 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
  • 39. 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
  • 40. 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