Health Systems Approaches to
Evidence-Informed Benefits Design:
Country Case Studies
1 | 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.
2 | Health Systems Approaches to Evidence-Informed Benefits Design: Country Case Studies
Contents
Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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
Overview
Achieving 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 evidenceinformed 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
4 | Health Systems Approaches to Evidence-Informed Benefits Design: Country Case Studies
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 “macrolevel” 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 noncommunicable 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”).
Health Systems Approaches to Evidence-Informed Benefits Design: Country Case Studies | 5
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 “microlevel” 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
6 | Health Systems Approaches to Evidence-Informed Benefits Design: Country Case Studies
As low- and middle-income countries continue efforts to achieve universal health coverage (UHC), macrolevel 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
1
Benefits design should be patient-centered, evidence-informed, and
holistic to effectively and efficiently increase equitable access to quality
health care services.
Principle
2
Benefits design should be aligned with local context and patient needs.
Principle
3
Benefits design should emphasize transparency and stakeholder
involvement.
Principle
4
Benefits design should promote increasing patient access to quality
services and care that prevent, slow progression of, or manage diseases.
Principle
5
Benefits design should inform decision-making and promote choice
in health care service delivery for health care providers and patients.
6
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.
Principle
Health Systems Approaches to Evidence-Informed Benefits Design: Country Case Studies | 7
Best practices in evidence-informed benefits
design: a global snapshot
Three case studies were identified as examples of macro-level HTA being successfully implemented in middleincome 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:
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).
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.
4
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.
8 | Health Systems Approaches to Evidence-Informed Benefits Design: Country Case Studies
CASE STUDY 1
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
1
2
3
4
5
6
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.
Health Systems Approaches to Evidence-Informed Benefits Design: Country Case Studies | 9
CASE STUDY 2
Hospital-based clinical pathways in China
Evidence-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 longterm 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
1
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.
2
Aligns with local context and patient needs
3
Transparent and inclusive of stakeholder involvement
4
Promotes increasing patient access to quality services and primary care
5
6
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.
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.
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 decisionmaking 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.
10 | Health Systems Approaches to Evidence-Informed Benefits Design: Country Case Studies
CASE STUDY 3
UDAY project in India
Health 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
1
2
3
4
5
6
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.
Health Systems Approaches to Evidence-Informed Benefits Design: Country Case Studies | 11
APPENDIX 1
CASALUD in Mexico
CHARACTERISTICS OF EVIDENCE-INFORMED DECISION MAKING
1
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.
2
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.
3
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.
4
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.
5
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.
6
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.
12 | Health Systems Approaches to Evidence-Informed Benefits Design: Country Case Studies
APPENDIX 2
Hospital-based clinical pathways in China
CHARACTERISTICS OF EVIDENCE-INFORMED DECISION MAKING
1
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.
2
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.
3
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.
4
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.
5
6
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.
Health Systems Approaches to Evidence-Informed Benefits Design: Country Case Studies | 13
APPENDIX 3
UDAY project in India
CHARACTERISTICS OF EVIDENCE-INFORMED DECISION MAKING
1
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.
2
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.
3
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.
4
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.
5
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.
6
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.
14 | Health Systems Approaches to Evidence-Informed Benefits Design: Country Case Studies
Notes
World Health Organization. (2010). World Health Report: Health System Financing, the Road to Universal Coverage. Geneva:
WHO.
1
Fendrick, M., Chernew, M., & Levi, G. (2009). Value-based insurance design: embracing value over cost alone. Am J Manag,
15:S277-S283.
2
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.
3
World Health Organization. (2007). Everybody's business: strengthening health systems to improve health outcomes: WHO's
framework for action. Geneva: WHO.
4
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).
5
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.
6
7
Chalkidou, K. et al. (2013). Health technology assessment in universal health coverage. Lancet; 382; e48-e49.
8
Ibid.
Glassman, A., & Chalkidou, K. (2012). Priority setting in health: building institutions for smarter public spending. Washington, DC:
Center for Global Development.
9
Fendrick, M., Chernew, M., & Levi, G. (2009). Value-based insurance design: embracing value over cost alone. Am J Manag,
15:S277-S283.
10
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.
11
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.
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.
15
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.
16
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.
17
McClellan, M. & Tapia-Conyer, R. (2015). Mexico: Preventing chronic disease through innovative primary care models. Brookings
Center for Health Policy.
18
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.
19
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.
20
21
Population Services International. (2013). Improving prevention, treatment, and management of diabetes in India. PSI Impact.
Health Systems Approaches to Evidence-Informed Benefits Design: Country Case Studies | 15
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16 | Health Systems Approaches to Evidence-Informed Benefits Design: Country Case Studies