Health Systems Approaches to Evidence-Informed Benefits ... · Health Systems Approaches to Evidence-Informed Benefits Design: Country Case Studies | 5 Although there are many evidence-informed

1 | Health Systems Approaches to Evidence-Informed Benefits Design: Country Case Studies

Health Systems Approaches to Evidence-Informed Benefits Design:Country Case Studies

© May 2015

Acknowledgments

This report was written by Stacy Kramer and Kate Schachern of Rabin Martin, with support from the Pharmaceutical Research and Manufacturers of America.

Rabin Martin is a global health strategy consulting firm that is committed to improving the health of underserved populations. Learn more about us at rabinmartin.com.


ContentsOverview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Best practices in evidence-informed benefits design: a global snapshot . . . . . . . . . . . . . 8

CASE STUDY 1: CASALUD in Mexico . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

CASE STUDY 2: Hospital-based clinical pathways in China . . . . . . . . . . . . . . . . . . . . . . . 10

CASE STUDY 3: UDAY project in India . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

APPENDIX 1: CASALUD in Mexico . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

APPENDIX 2: Hospital-based clinical pathways in China . . . . . . . . . . . . . . . . . . . . . . . . . . .13

APPENDIX 3: UDAY project in India . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14

Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15


OverviewAchieving the goals of universal health coverage (UHC) in low- and middle-income countries requires a

holistic approach that examines the effectiveness and efficiency of the entire health care system.* At its

core, UHC is the idea that all citizens should have access to the health care they need without experiencing

financial hardship as a result.1 The concept of UHC is not new, but it has gained importance and visibility on

the global health agenda in recent years.† UHC has become an increasingly salient issue for both developed

and developing countries in the context of the global economic crisis, increasing health care demands, and

still unmet medical needs. Each country will find its own path to UHC, depending on its unique mix of disease

burden; health system policies, infrastructure, and financing; and economic, political, and cultural resources.

Regardless of how they get there, countries that succeed in making UHC a reality rather than an aspiration

will need to define a package of health benefits and services appropriately tailored to country needs.

To expand population coverage and the benefits package available for patients to use, consideration should

be given to an evidence-informed approach that manages not only the health technologies to be included

– such as drugs and medical devices – but also how the overall system achieves improvements in health

outcomes.2 The need for systems-wide evidence-informed policymaking has been widely accepted and is

currently one of the six health systems strengthening priorities for the World Health Organization.3 4 5

For example:

• In December 2012, approximately 100 countries adopted the United Nations (UN) General Assembly

resolution requesting the Secretary-General to investigate how countries have established and

strengthened institutional capacity to generate country-level evidence-informed decision-making

on the design of UHC.6

• Recently, an international workshop convened by NICE International, and supported by the Rockefeller

Foundation and the UK’s Department for International Development (DFID), concluded that health

technology assessment (HTA) in the context of health delivery systems is a critical component of evidence-

informed policymaking and, furthermore, provides an essential foundation to securing UHC.7

• The Center for Global Development’s Task Force on Priority Setting in Health also supports the use of HTA

as a tool for achieving UHC, but notes that HTA in low- and middle-income countries need to be adapted

to local needs and broader in scope than HTA in developed countries due to important questions of

equity, shared value, and operational feasibility.8 9

Health Systems Approaches to Evidence-Informed Benefits Design: Country Case Studies | 5

Although there are many evidence-informed decision-making tools available, governments frequently rely

on HTA to help set priorities for important health system decisions, including benefits package design.

Although less frequently used, “macro-level” HTA has the potential to be utilized in evidence-informed

benefits design, or the process by which policy makers decide what products and services will be covered,

to achieve the broader goals of UHC more holistically.‡ Policy makers should therefore consider “macro-

level” HTA as an evidence-informed benefits design tool to improve the overall efficiency and quality

of health care. By having a broader, patient-centered approach, evidence-informed benefits design can

inform priority setting, improve health outcomes, help avoid catastrophic expenditure, and improve patient

quality of life by increasing access to health information; immunization and other prevention initiatives; and

improved diagnostics, treatment, care coordination, and disease management for both infectious and non-

communicable diseases.10 11 12

* According to the World Bank definition for the 2015 fiscal year, low- and middle-income countries are classified as economies with GNI per capita of $12,746 or less. † The detailed definition from World Health Assembly Resolution 58.33 is as follows: “Universal coverage is defined as access to key promotive, preventive, curative and rehabilitative health interventions for all at an affordable cost, thereby achieving equity in access. The principle of financial-risk protection ensures that the cost of care does not put people at risk of financial catastrophe.” World Health Assembly. (2005, May 25).Resolution 58.33. Ninth plenary meeting, Committee A, eighth report. Available at: http://www.who.int/health_financing/documents/cov-wharesolution5833/en/.

‡ Currently there is no consistent and agreed-upon terminology used when discussing the concept of benefits design. In this issue brief, we use the term “evidence-informed benefits design” to refer to the development of benefits packages in low- and middle-income countries. However, other stakeholders use different terminology to discuss the same concept (e.g., the World Bank and the World Health Organization use the terms “essential benefits package” and “base benefits package,” while the United Kingdom’s National Health Service prefers “minimum benefits package”).


What is health technology?

According to Health Technology Assessment international (HTAi), health technology encompasses pharmaceuticals, devices, diagnostics and treatments, and other clinical, public health, and organizational interventions developed to solve a health problem and improve quality of lives.13 Although health technology is most often associated with pharmaceuticals and medical devices, it also refers more broadly to interventions that promote health – including preventive screening, rehabilitation programs, service delivery, payment of providers, and health system infrastructure interventions.

What is health technology assessment?

Health technology assessment refers to the process of using existing research evidence to evaluate the impact of a given health technology on patients and the health care system as a whole.14 The scope and methods of HTA may be adapted to respond to the policy needs of a particular health system. Policy makers in most developed countries and, increasingly, in many low- and middle-income countries, use HTA to determine the impact of “micro-level” health interventions, particularly in regards to medicines and medical devices.

Health technology assessment can be categorized into two primary types:

1, “Micro-level” HTA focuses on the appraisal of individual technologies, most commonly medicines and medical devices in developed countries. There is wide variation across a number of criteria among countries implementing “micro-level” HTA. Some countries (e.g., the UK) assess the cost-effectiveness of health technologies by instituting thresholds of cost per unit of measured benefit (as measured by Quality Adjusted Life Years or QALYs). Other countries (e.g., the Netherlands and Sweden) also assess cost-effectiveness using QALYs, but have no threshold. Still others (e.g., France and Germany) do not employ cost-effectiveness analysis or QALYs in their assessments at all.

2. “Macro-level” HTA is concerned primarily with the efficiency of organizational systems or health system architecture (e.g., incentive systems, clinical guidelines, patient pathways of care, and optimizing facilities) and is used to support health policy development and prioritization of health care interventions.15


As low- and middle-income countries continue efforts to achieve universal health coverage (UHC), macro-level health technology assessment (HTA) can be utilized to design evidence-informed benefits packages. Successful implementation of this tool can have a significant impact in ensuring effective, high-quality health care services as countries work to reform their health systems. In the following sections, we have identified case studies and a diverse range of best practices demonstrating how macro-level HTA can be tailored to fit distinctive geographical and cultural settings while still maintaining a comprehensive approach to strengthening health systems.

Though unique, each case study takes a systems-wide approach to HTA, engaging patients, providers, and stakeholders; adapting to local needs; promoting disease management and prevention; utilizing evidence to inform decisions; and introducing new tools and best practices. Each of the following case studies has been analyzed for alignment with the innovative biopharmaceutical industry’s proposed policy principles regarding the design of patient-centered, evidence-informed benefits packages for universal health coverage.16

Principle

Principle

Principle

Principle

Principle

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Benefits design should be patient-centered, evidence-informed, and holistic to effectively and efficiently increase equitable access to quality health care services.

Benefits design should be aligned with local context and patient needs.

Benefits design should emphasize transparency and stakeholder involvement.

Benefits design should promote increasing patient access to quality services and care that prevent, slow progression of, or manage diseases.

Benefits design should inform decision-making and promote choice in health care service delivery for health care providers and patients.

Benefits design should encourage experimentation in health system interventions and promote innovation, including investment in R&D, across the spectrum of prevention, diagnostics, treatment, care, and support.


Best practices in evidence-informed benefits design: a global snapshotThree case studies were identified as examples of macro-level HTA being successfully implemented in middle-income countries to promote access to quality and appropriate health care. For each case study, we have provided an overview of the initiative along with detailed rationale outlining how it is aligned with each of the guiding principles for evidence-informed benefits design. Appendices 1, 2, and 3 provide a more in-depth description of each program’s components and alignment with the policy principles. The case studies selected were:

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HOSPITAL-BASED CLINICAL PATHWAYS IN CHINA

A pilot program to increase the quality, affordability, and efficiency of care in China’s public hospitals through evidence-based clinical pathways.

UDAY PROJECT IN INDIA

A five-year, operational research initiative to implement and evaluate interventions and

new tools for the prevention, detection, and treatment of diabetes and hypertension

in India.

CASALUD IN MEXICO

A comprehensive health care model in Mexico using best

practices and new innovations to improve care, control, and

prevention of noncommunicable diseases (NCDs).


CASALUD in Mexico A comprehensive health care model in Mexico, CASALUD, has shown that a broad approach to changes in health care infrastructure is essential to changing health care paradigms. The World Health Organization (WHO) and United Nations (UN) have used data on a wide variety of factors – from obesity rates and diet quality, to health facility capacity and consultation quality – to inform a multi-sector approach to address rising NCD rates. CASALUD, derived from the Spanish words for home (casa) and health (salud), was initiated by the Carlos Slim Health Institute/Foundation as an innovative health care model to leverage these international best practices and use innovative technology to deliver NCD care, control, and prevention. After studying lessons learned from initial implementation, the program plans to partner with the Mexican Ministry of Health to expand throughout the country.

Examples of CASALUD’s strategies demonstrate support for solutions that are aligned with local context and patient needs and designed to help patients take responsibility for their own health – a low-cost mobile phone application allows health care providers and patients to report drug shortages, and an easily accessible diploma program builds local capacity for NCD care. Furthermore, CASALUD extends beyond clinical data: adequate supply of medicines, stronger human capital, proactive prevention strategies, and enhanced access to care are pillars of the plan. Additional information is available in Appendix 1; and study results have been published in Perspectives in Public Health and shared by the Brookings Center for Health Policy.17 18

KEY CHARACTERISTICS OF CASALUD This case study shows alignment with an evidence-informed decision-making framework

Patient-centered, evidence-informed, and holistic CASALUD’s goal is to be a comprehensive and sustainable model of continuous access to NCD care through the incorporation of program components into the public health care system.

Aligns with local context and patient needs The program addresses specific needs identified in the Mexican health system for NCD prevention, treatment, and human capital, and provides portable screening tools for use in clinics, homes, and the community.

Transparent and inclusive of stakeholder involvement An evaluation identified lessons learned from initial program implementation and made results available to stakeholders and the public.

Promotes increasing patient access to quality services and primary care A main objective is to encourage health rather than treat disease through patient outreach, health promotion, and the provision of services such as risk assessments and disease screenings.

Informs decision-making and promotes choice for providers and patients The model includes continuing education for health providers, screening tools with personalized recommendations, patient education, and a diabetes diary for monitoring and feedback.

Encourages experimentation and innovation in health system interventions and R&D The program increases early access to health care through the use of new technological innovations and mobile screening tools, which are evaluated to assess effectiveness, usefulness to patients, utility, and uptake.

CASE STUDY 1

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Hospital-based clinical pathways in ChinaEvidence-informed decision-making is being utilized in China to institute system-wide health care reforms. As

part of a pilot program to increase the quality, affordability, and efficiency of care in China’s public hospitals, the government has worked with NICE International to develop evidence-based clinical pathways. These pathways, which describe standards of care, have been utilized as a way to improve providers’ clinical practices and decrease national health care spending. Rather than focusing on specific products, the pathways have served to promote and disseminate best practices and standards of care across the country’s rural public hospitals. The use of flexible clinical pathways has also allowed physicians to separate medical decision-making from concerns about revenue, increasing both patient and provider satisfaction with care. This pilot program has already produced improvements in clinical care and cost savings, suggesting that future outcomes of the program may have long-term benefits for health care reform in China. Additional information is available in Appendix 2; and study results have been published in Health Affairs.19

KEY CHARACTERISTICS OF CHINA CLINICAL PATHWAYS PROJECT This case study shows alignment with an evidence-informed decision-making framework

Patient-centered, evidence-informed, and holistic Physicians believed that the program’s evidence-based clinical pathways were helpful to patients, and study results found increased satisfaction from both patients and health care providers.

Aligns with local context and patient needs Diseases for the clinical pathways were chosen based on common conditions and prevalent diseases found in rural China, and the pathways were adapted over time to meet local conditions and needs.

Transparent and inclusive of stakeholder involvement The effects of the evidence-based clinical pathways were studied using pilot and control hospitals, with results of the evaluation published in Health Affairs and made available to stakeholders and the public.

Promotes increasing patient access to quality services and primary care A main goal of the program was to improve the quality of services and care at rural public hospitals.

Informs decision-making and promotes choice for providers and patients Clinical practices were flexible, with required and elective choices that allowed providers to have decision-making power over optional services based on patient needs. Physicians felt that the pathways allowed them to separate clinical- and revenue-based decisions.

Encourages experimentation and innovation in health system interventions and R&D Clinical pathways were also used as tools for continuing medical education and the rapid distribution of new clinical advances and best practices.

CASE STUDY 2

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UDAY project in IndiaHealth technology assessment is being used in India to address the country’s rising NCD burden through the UDAY project, an operational research initiative that creates a comprehensive approach to disease management. The goal of the five-year project is to implement and evaluate system-wide interventions for the prevention, detection, and treatment of diabetes and hypertension. Developed in collaboration with the Lilly NCD partnership, Population Services International (PSI), the Public Health Foundation of India (PHFI), and Project HOPE India, the UDAY Project broadens the scope of traditional chronic care interventions beyond the clinic to improve patient outcomes, build capacity of health care providers, and empower patients to take a larger role in their care.

The UDAY program promotes evidence-based best practices, including management algorithms to help providers screen, diagnose, and create individualized case management plans. Quality improvement plans and disease registries are utilized to improve detection and management of patients through risk assessments and guideline-based therapies. Innovations employed by the program include an integrated m-Health system; tablet-based surveys; distance learning and continuing medical education for providers; social marketing campaigns; and GIS mapping to conduct spatial and built environment assessments. Additional information is available in Appendix 3; and preliminary findings have been presented at the ISPOR 6th Asia-Pacific Conference and shared in PSI Impact.20 21

KEY CHARACTERISTICS OF UDAY PROJECT This case study shows alignment with an evidence-informed decision-making framework

Patient-centered, evidence-informed, and holistic The project reaches all levels of the health system, targeting patients, physicians, community health workers, and pharmacists.

Aligns with local context and patient needs The program evaluates the level of conformity of the health system to recommendations in the Indian Public Health Standards; conducts spatial and built environment assessments of providers, pharmacies, and public health facilities; and utilizes local pharmacists and community health workers to facilitate task shifting.

Transparent and inclusive of stakeholder involvement Regular meetings are held with local health, administrative, and community stakeholders to engage them in the project.

Promotes increasing patient access to quality services and primary care The project includes a qualitative study of opportunities and barriers to utilizing health services, as well as perceived risk of disease, with results informing a mass media campaign to educate the public.

Informs decision-making and promotes choice for providers and patients The program looks at whether education can increase (1) levels of self-referral and prevention by patients and (2) screening and implementation of evidence-based guidelines by providers, in addition to offering providers Decision Support Software with evidence-based management algorithms.

Encourages experimentation and innovation in health system interventions and R&D Multiple new technologies are incorporated into the initiative, including an m-Health component with Decision Support Software that uses evidence-based treatment guidelines to help providers screen, diagnose, and develop management plans for individual patients.

CASE STUDY 3

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CASALUD in Mexico

Patient-centered, evidence-informed, and holistic • Four pronged program includes: (1) ensuring an adequate supply of medicines and diagnostics; (2) strengthening

human capital through continuing medical education; (3) integrating proactive prevention strategies within the community and households; and (4) increasing early access to health care through strategic use of technological innovations.

• The program approach focuses on comprehensively integrating components into the public health system.

• CASALUD stresses implementing models within a holistic and structured NCD framework.

Aligns with local context and patient needs• Interventions can be used in clinics, public places, and households (e.g., portable screening tool that connects

to mobile phones and can be used in subway stations, supermarkets, and other places).

• The program addresses specific needs identified in the Mexican health care system for strengthening human capital, NCD prevention, and disease treatment.

Transparent and inclusive of stakeholder involvement• Lessons learned from initial implementation of CASALUD include identifying leaders to increase

accountability and engaging health care workers to secure buy-in.

• A mobile phone application was created to reduce stock-outs by promoting accountability throughout the medical supply chain, thereby improving logistics and efficiency.

Promotes increasing patient access to quality services and primary care• The program’s core intervention utilizes an integrated and systematic risk assessment tool to

screen patients as healthy, at risk for disease, or sick.

• The main objective is to improve health rather than treat disease through patient outreach, health promotion, and service provision throughout the continuum of care.

• Tools measure risk factors and physiological data such as BMI, blood glucose, and urinary protein.

Informs decision-making and promotes choice for providers and patients• A screening tool provides personalized recommendations for NCD prevention based upon individual

risk level to encourage informed decision-making and patients’ ownership of their health.

• A diabetes diary empowers diabetes patients to improve their treatment adherence through personalized monitoring protocols and feedback.

• A diploma program on NCDs and a digital portfolio featuring health calculators and guidelines allows CASALUD to integrate best practices into health education and training for health care providers.

Encourages experimentation and innovation in health system interventions and R&D• The program utilizes new technologies and screening tools, such as a low-cost application to decrease

risk for CVD and unhealthy lifestyles through patient education and self-assessment. Results are shared with physicians to create the best strategies to prevent or manage chronic diseases.

• Tools were evaluated using qualitative analyses to look at their utility, user-friendliness, and uptake.

APPENDIX 1

CHARACTERISTICS OF EVIDENCE-INFORMED DECISION MAKING

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Hospital-based clinical pathways in ChinaAPPENDIX 2

Patient-centered, evidence-informed, and holistic • The program goal was to implement evidence-based clinical pathways to increase the quality, affordability, and

efficiency of care in China’s rural public hospitals.

• Physicians were satisfied with clinical pathways, and felt that the pathways were beneficial from a professional perspective, allowed them to separate clinical behavior from revenue issues, and were helpful to patients.

Aligns with local context and patient needs• Clinical pathways were adapted over time to meet local conditions and needs.

• Conditions for clinical pathways were determined based on common diseases and medical events occurring in rural China.

• Pilot hospitals were encouraged to include additional diseases with high incidence rates among their local populations or listed in the local disease registry, provided that the hospitals had the technical competency and ability to appropriately treat the diseases.

Transparent and inclusive of stakeholder involvement• An evaluation of the program studied the effect of the clinical pathways in pilot and control hospitals,

with results of the study published in Health Affairs.

• The program team utilized international best practices to compare and update existing clinical pathways that had been previously developed by Chinese clinical experts.

• The Chinese Ministry of Health signed two memoranda of understanding with NICE International to provide the government with technical assistance to develop evidence-based clinical pathways.

Promotes increasing patient access to quality services and primary care• Specific goals included improving quality of care at rural public hospitals through behavior modification

with evidence-based clinical pathways; decreasing out-of-pocket spending; and increasing efficiency in rural hospitals through payment reform and decreases in overtreatment.

• Results included reduction in length of hospital stay and increases in patient and provider satisfaction.

Informs decision-making and promotes choice for providers and patients• Clinical pathways were flexible, with “required” and “elective” choices that allowed providers to

have decision-making power over elective services based on patient needs.

Encourages experimentation and innovation in health system interventions and R&D• Evidence-based clinical pathways were used as tools for continuing medical education and

rapid distribution of new clinical advances and best practices.


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UDAY project in IndiaAPPENDIX 3

Patient-centered, evidence-informed, and holistic • Operational research project designed to prevent, treat, and manage diabetes and hypertension in India, reaching

400,000 patients over five years.

• The UDAY project offers comprehensive intervention package of services at multiple levels of the health system.

• The program aims to broaden the scope of traditional chronic care interventions beyond the clinic, improve patient outcomes, and allow patients to take more ownership of their disease management.

• Surveys evaluate access, supply chain, drug supply, barriers to care, and level of conformity to the Indian Public Health Standards recommendations in the health care system.

Aligns with local context and patient needs• E-screening program incorporates demographic and lifestyle information and risk analysis.

• Pilot sites in northern and southern regions of the country include rural and urban sub-sites.

Transparent and inclusive of stakeholder involvement• The program partners with district health care systems and communities for program launches.

• Regular meetings are held with local health, administrative, and community stakeholders.

Promotes increasing patient access to quality services and primary care• The program studies perceived risk and susceptibility about diabetes in the general population, as well as

opportunities and barriers to utilize health care services, with a media campaign based on the results.

• Pharmacists are trained and viewed as a crucial link between providers and the community.

• Interventions include health promotion programs, risk assessments and screening, patient education, provider training, disease registry and quality improvement programs, and access to care advocacy.

Informs decision-making and promotes choice for providers and patients• The UDAY project aims to broaden the scope of traditional chronic care interventions beyond the clinic, improve

patient outcomes, and allow patients to take more ownership of their disease management.

• The program looks at effects of public and provider education on increased self-referral and prevention in patients, and diabetes screening and evidence-based guideline utilization in health care workers.

• The program builds capacity for health care workers to downshift care through training, continuing medical education, distance learning, and guidance through context-specific evidence-based guidelines.

• Decision Support Software applications (DSS) utilize evidence-based management algorithms to help providers screen, diagnose, and create individualized management plans.

Encourages experimentation and innovation in health system interventions and R&D• Innovations and best practices include an integrated m-Health system; distance learning, continuing medical

education, trainings, and quality improvement plans for health care providers; tablet based surveys to capture electronic medical data; health promotion and screening efforts; GIS mapping to conduct spatial and built environment assessments; social marketing initiatives to improve the quality of pharmacies; and a registry to promote early diagnosis and help prevent complications.

• Decision Support Software applications (DSS) utilize evidence-based management algorithms to help providers screen, diagnose, and create individualized management plans.


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1 World Health Organization. (2010). World Health Report: Health System Financing, the Road to Universal Coverage. Geneva: WHO.

2 Fendrick, M., Chernew, M., & Levi, G. (2009). Value-based insurance design: embracing value over cost alone. Am J Manag, 15:S277-S283.

3 Oxman, AD., Fretheim, A., Schünemann, HJ., & Subcommittee on the Use of Research Evidence (SURE) of the WHO Advisory Committee on Health Research (ACHR). (2006). Improving the use of research evidence in guideline development: introduction. Health Res Policy Syst, 4: 12.

4 World Health Organization. (2007). Everybody's business: strengthening health systems to improve health outcomes: WHO's framework for action. Geneva: WHO.

5 Bosch-Capblanch. X., Lavis, JN., Lewin, S., Atun, R., Røttingen, J-A. et al. (2012). Guidance for evidence-informed policies about health systems: rationale for and challenges of guidance development. PLoS Med, 9(3).

6 United Nations General Assembly (GA/11326). (2012). Adopting consensus text, General Assembly encourages member states to plan, pursue transition of national health care systems towards universal coverage. New York: United Nations. Available at: http://www.un.org/press/en/2012/ga11326.doc.htm.

7 Chalkidou, K. et al. (2013). Health technology assessment in universal health coverage. Lancet; 382; e48-e49.

8 Ibid.

9 Glassman, A., & Chalkidou, K. (2012). Priority setting in health: building institutions for smarter public spending. Washington, DC: Center for Global Development.

10 Fendrick, M., Chernew, M., & Levi, G. (2009). Value-based insurance design: embracing value over cost alone. Am J Manag, 15:S277-S283.

11 Chernew, M., Juster, I., Shah, M., Wegh, A., Rosenberg, S., Rosen, A., Sokol, M., Yu-Isenberg, K., & Fendrick, A. (2010). Evidence that value-based insurance can be effective. Health Affairs, 29(3): 530-536.

12 Chernew, M., Rosen, A., & Fendrick, A. (2007). Value-based insurance design. Health Affairs, 26(2): w195-w203.

13 Health Technology Assessment international (2014). What is HTA? Available at: http://www.htai.org/index.php?id=428.

14 Ibid.

15 Towse A; Devlin N; Hawe E; and Garrison L (2011). The evolution of HTA in emerging markets health care systems: analysis to support a policy response. Office of Health Economics Consulting.

16 EFPIA, IFPMA, JPMA, & PhRMA. (April 2015). Evidence-Informed Benefits Design in the Context of Universal Health Coverage: Proposed Policy Principles. Available at http://www.ifpma.org/fileadmin/content/Publication/2015/Evidence-Informed_Benefits_Design_in_the_Context_of_UHC.pdf.

17 Tapia-Conyer, R., Gallardo-Ricon, H., & Saucedo-Martinez, R. (2013). CASALUD: an innovative health-case system to control and prevent non-communicable diseases in Mexico. Perspectives in Public Health, 1-11.

18 McClellan, M. & Tapia-Conyer, R. (2015). Mexico: Preventing chronic disease through innovative primary care models. Brookings Center for Health Policy.

19 Cheng, Tsung-Mei. (2013). A pilot project using evidence-based clinical pathways and payment reform in China’s rural hospitals shows early success. Health Affairs, 32(5): 963-73.

20 Prabhakaran, D. (September 2014). UDAY: A comprehensive diabetes and hypertension prevention and management program in India. Presentation at ISPOR 6th Asia-Pacific Conference. Beijing, China.

21 Population Services International. (2013). Improving prevention, treatment, and management of diabetes in India. PSI Impact.

Notes


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Health Systems Approaches to Evidence-Informed Benefits ... · Health Systems Approaches to Evidence-Informed Benefits Design: Country Case Studies | 5 Although there are many evidence-informed