STANCE #23 – NOVEMBER EDITION
By Belinda McEniery
The People’s Republic of China’s (PRC) Healthy China 2030 initiative has put health as an explicit national policy priority, and a focus of China’s policymaking apparatus. As the PRC strives towards universal access to public health, the health technology assessment (HTA) framework has been increasingly adopted as a mechanism to manage sustainable access to healthcare. While Australia has a long history of implementing the HTA framework, critical policy lessons arise for Australia from the PRC’s adoption of HTA.
HTA is the framework used by public health systems, including Australia’s, to manage sustainable access to the best medical practices within the constraints of a limited health budget. Essentially, HTA uses clinical evidence to provide policymakers, health professionals and consumers with an understanding of the benefits and comparative value of health technologies and procedures. In Australia, HTA is the key principle underpinning the government’s Pharmaceutical Benefits Scheme (PBS) and Medicare Benefits Scheme (MBS).
Following the inception of Healthy China 2030, the first medium-to-long term strategic plan in the health and development sector, the PRC has made significant progress in improving public health coverage. There are undeniable challenges in providing cost-effective healthcare in a country with a geographic diversity comparable to Australia but a population approximately 60 times the size. Ma Xiaowei, Director of the PRCs National Health Commission described HTA as “a precondition for achieving Healthy China 2030…and a new approach to the supervision and reimbursement approach of the market economy in China.”
The PRC is now in the enviable position of learning from the policy experience of countries with an established HTA system and to choose the aspects that will be emulated. Inevitably, the PRC government will also benefit from the buying power associated with a population of 1.4 billion people and as such, substantial benefit will be derived from a centralised and consistent process of health evaluation. In 2017, the PRC held its first pilot of negotiations for innovative drugs. Many more are expected before the evaluation system is finalised. Even in its infancy, the PRC system has made substantial improvements on the Australian implementation of HTA and is posited to ‘leap-frog’ Australia in offering the latest health innovations, developing new models of care and applying them at scale. This is exemplified in the PRC’s race to introduce CAR-T, a personalised medicine for the treatment of various types of cancer, to the mainstream. There is a larger number of CAR-T clinical trials currently registered in the PRC, compared to the U.S.
Critical policy lessons arise for Australia from the PRC’s implementation of the HTA framework, including:
1. Like the PRC, Australia should place a greater emphasis on the advent of personalised medicine. While Australia does not have a comparative advantage in the human capital-intensive process of CAR-T, the Australian HTA system should aim to be a global leader in the valuation of CAR-T, as an experiment for future innovations in personalised medicine. Australia must demonstrate the flexibility of HTA by adapting to the evaluation of new and innovative technologies that do not necessarily fit neatly into the categories of ‘medicine’ or ‘medical service.’
2. Australia should adopt a longer-term strategic planning framework for the PBS and MBS, de‑coupled from the federal budget and federal election cycles. Pragmatic, system-level and forward-looking considerations should be factored into reimbursement guidelines, with the aim of future-proofing the reimbursement of treatments and to untying funding from soon-to-be outdated treatments.
3. Australia should also pool capabilities with the PRC in the approval of clinical trial protocols that will allow multi-centre clinical research across PRC and Australian centres. With a government push to attract more clinical trials to the country, and the favourable landscape for clinical trials in Australia, we should capitalise on our clinical trial infrastructure and proximity to Asia to boost the value and attractiveness of clinical trial sites in Australia. Further, these trials should be followed with agreements for ‘work-share arrangements’ in the evaluation of clinical evidence derived from such trials, to support HTA capacity building and facilitate earlier access for patients in both Australia and the PRC.
The increased adoption of HTA in the PRC presents an opportunity for Australia to review our own implementation of HTA, and to further showcase the adaptability and responsiveness of our HTA framework to the exciting medical technologies of the future.
Belinda McEniery is a Health Economics Associate at Johnson & Johnson and Schwarzman Scholars Alumni.
The opinions expressed in this article are the author’s and do not represent the views of China Matters.