Achieving the digital transformation of health systems in China

Currently, global healthcare is under immense stress due to changes in demography, age, and an increase in levels of chronic diseases. To ensure a strong and sustainable healthcare system an integrated approach that utilises the latest tools in the medical field is necessary. In this article, Nicole Denjoy, secretary general of COCIR, supported by Jessica Yuan, manager of COCIR China Desk and senior government affairs desk manager at the European Chamber, list the reasons why a patient-centred approach can benefit China, as well as the rest of the world.

Introduction

We urgently need to address global healthcare challenges, including demographic change, ageing populations and increasing levels of chronic disease.s The stress of these burdens is increasingly rendering healthcare systems unsustainable.

We know that ‘health is wealth’, which is why investing effectively in healthcare will produce long-term economic and societal benefits. New technologies that contribute to better care include, but are not limited to, non-invasive techniques, medical imaging and radiotherapy. Digital health solutions also offer huge potential. Inexorably, healthcare systems will increasingly depend on digital technology.

Currently, health and social systems are designed for different demographics, epidemiology and lifestyles. Healthcare services, and service delivery, need to be reconfigured around people’s needs and preferences. In 1960, the portion of the population over 65 years old was less than 10 per cent. The number of people over 65 doubled by 2015, and is projected to reach almost 30 per cent of the population by 2060. In addition, not only are people living longer, but as they become elderly they are increasingly facing complex medical problems. This complexity arises largely from co-morbidities that are often chronic, such as: type 2 diabetes, hypertension, cardiovascular disease, and pulmonary disease. In many countries, people with a single chronic condition make up 80 per cent of their disease burden, while people with multiple chronic conditions make up about half. The increasing number of premature deaths from chronic conditions are impacting economic performance, with falling labour market participation and reduced work productivity. Non-communicable diseases cause more than 550,000[1] premature deaths in people of working age each year, a loss of 3.4 million years of productivity. This is especially true in China, a populous country whose population has been aging rapidly.

In addition, there has been a profound shift in how society cares for its elderly. Only a generation ago, adult children helped care for the majority of the elderly in their own homes. However, as more women began working, families increasingly looked to nursing home care for their elderly relatives. Health systems are struggling to meet the challenges posed by this demographic shift to an ageing population along with the growing burden of chronic diseases and related co-morbidities.

Health and social care fragmentation

It is increasingly clear that too many health and social care systems are unnecessarily fragmented. They were not meant to provide specialised support for individual medical needs, as well as helping to cope with the challenges of independent living. The growing complexity of care generated by physical and mental health co-morbidity, combined with other factors related to ageing populations translate into an increasing burden for long-term care services.

Information is not shared efficiently between service providers, meaning patients do not receive coordinated care focused on their needs. In fact, the reality for many citizens is that they have to navigate their own path between different healthcare providers. There is a lack of emphasis on engaging and empowering people; health and care systems have failed to adequately engage, empower and support people to become health literate and manage their own care, share in decision-making, empowering them to become partners in health. In reality, however, overburdened patients face difficulties communicating complex care needs and medical histories across healthcare services. This approach inevitably drives up healthcare costs by relying on unscheduled or emergency care services. In addition, the fragmented and often underdeveloped data collection on health outcomes makes it difficult to compare the value of different care interventions, prioritise decision-making across care providers and assess health system performance. This frequently leads to inefficient health and care delivery, poorer medical outcomes, unjustified clinical variability in medical practices and decision-making across care providers.

Leadership from the government

What will it take to address this fragmentation and reconfigure services around people and their needs, preferences and expectations? The answer lies in transforming delivery mechanisms into a more person-centred approach that encompasses health and social care. Countries need to focus on the concept of ‘integrated care’—essentially a person-centred and coordinated approach that crosses the boundaries between hospital, primary, community and social care. This new method of care requires support for: multi-year funding; stakeholder engagement; increased education; organisational changes; new financing mechanisms; a welcoming regulatory environment; and the scaling up of digital health innovation. Governments need to establish an enabling ecosystem to support integrated care. This enabling ecosystem could mean the implementation of new financing models, adequate incentives for health and care providers, and a regulatory environment that successfully strikes a balance between innovation and data privacy protection. Developing a process for multi-stakeholder collaboration,[2] could include a new organisational and communications platforms that help to implement shared care pathways, improve disease management and increase health literacy.

Governments should also promote interoperability[3] by supporting semantic and technical standards, standardised measurement of health outcomes including patient-reported outcomes. They should build on existing digital health solutions, such as citizen/patient identifiers or electronic health records that enable data extraction for care delivery and secondary purposes and incentivise healthcare professionals to standardise how they register clinical data. They could help develop integrated care models with specific initiatives, including sharing and replicating good practice and scaling up successful implementation.[4]

Governments need to provide political leadership and develop national and regional evidence-based roadmaps to drive the transition to integrated care delivery systems that are better tailored to people’s needs. Digital health supports integrated and patient-centric care, encouraging a value-based healthcare approach that improves the outcomes and experiences for both patients and the wider population while ensuring the healthcare system remains sustainable.

Integrated care approach in China

China has worked hard in trying to adopt a more integrated healthcare model by reviewing case studies and learning from the experiences of other high-income and middle-income countries. China has undertaken its own innovations when it comes to health reform. Five ministries and commissions issued the report titled Deepening the Reform of China’s Medical and Health System,[5] which aimed to develop the value-based, high-quality service supply system. It is encouraging to see China’s health service system becoming more people-oriented and integrated. China is going to establish a strong primary health service which will not only provide an increased quantity and quality of different medical services for its citizens, but will also improve health services from a cost-saving perspective.

Health reform needs to be continually supported, not only in China, but in other countries as well. An integrated approach will be needed to ensure innovative medical technology and health service techniques can play a prominent role in modernising healthcare around the world.

[1] OECD 2016 Health at a Glance Ref. <http://www.oecd.org/health/health-at-a-glance-europe-23056088.htm>

[2] Refer to multi-stakeholder initiative http://www.integratedcarealliance.org

[3] Refer to Joint initiative on Interoperability http://www.cocir.org/uploads/media/17022_COC_Interoperability_web.pdf

[4] COCIR publication on improving workflows http://www.cocir.org/uploads/media/16058_COC_eHealth_WORKFLOWS_position_paper_web.pdf;COCIR publication on Blue Print Roadmap http://www.cocir.org/uploads/media/17023_COC_Blueprint_24-04-17.pdf

[5] Deepening the reform of China’s medical and health system, World Bank Group, WHO, MoF, NHFPC, MoHRSS, <http://www.wpro.who.int/china/publications/health-reform-in-china.pdf>

Nicole Denjoy is the COCIR Secretary General since 2005. She has gathered more than 30 years’ experience in the medical technology industry and is also the Vice Chair of DITTA, the Global Trade Association representing Medical Imaging, Radiation Therapy and Healthcare IT Industry (www.globalditta.org). COCIR is the EU leading industry voice on digital health. COCIR and its members develop a number of activities to reduce market fragmentation and accelerate the deployment of digital health in Europe.