Held during ISPOR 2024 Conference, Atlanta, GA, USA
The ISPOR Asia Consortium meeting took place on 06 May 2024 in Atlanta, USA during ISPOR 2024. This meeting featured a presentation on “Reimbursement of Innovative Health Technologies in South Korea” and HEOR and health policy updates from Australia, China, India, Japan, and Singapore in the Asia Pacific region. Bruce Crawford, General Manager of Vista Health Japan KK, Japan, moderated the meeting. ISPOR CEO Rob Abbott delivered a warm welcome by highlighting ISPOR Strategic Plan 2030 and the vision and mission for the Asia Pacific region under his leadership. ISPOR Global Member Engagement Director Robert Selby provided an update on major activities of ISPOR Asia Consortium in 2024. 90 people participated in the event. This brief summarized a couple of reflections from the speakers.
Reimbursement of Innovative Health Technologies in South Korea
Presented by: Young Ae Jeong, Director General of Benefit Listing Department, Health Insurance Review and Assessment Service (HIRA), Seoul, South Korea
In recent years, there has been great interest in AI or digital therapeutics (DTx) in South Korea. The laws were enacted, and the government made special fast tracks to speed up clinical entry for AI & DTx. In 2021, the reimbursement plan was reported to the National Health Insurance Policy Deliberation Committee and NHI began temporarily covering costs at the end of last year.
At the end of 2023, temporary listing guidelines and operating instructions for AI & DTx were released. A total of 19 technologies have been approved. Among them, eight are AI technologies and two are DTx. AI & DTx are allowed for clinical use for up to 3 years, and companies can choose whether or not to receive health insurance coverage. Companies must submit a report on clinical research results after three years.
DTx has physician's fee and software (mobile application) usage fee. There are two types of physician's fee. The software usage fee is currently under review and will be determined soon. Considering that AI is a tool to assist doctors in diagnosing various diseases, an additional fee is charged to existing medical fees. They were divided into four groups based on similarity. There is a cap of to prevent overuse and burden on patients.
Regular monitoring will be conducted during the temporary period. Through monitoring, we plan to check usage volume, usage patterns, patient compliance, and social issues. Programs and prices for each hospital are disclosed on the HIRA website. The final price and co-payment rate will be decided based on monitoring results, cost-effectiveness, clinical outcomes, etc. only if proven clinical effectiveness.
DRG/DIP Payment Reform in China
Presented by: Wen CHEN, PhD, Professor and Director of Pharmacoeconomic Research and Evaluation Center, Fudan University, Shanghai, China.
China's social medical insurance is currently undergoing the DRG/DIP payment reform for inpatient payment. This reform has been piloted since 2019, with 30 cities designated as pilot cities for DRG payment reform and 71 pilot cities for DIP payment reform. Later on, DRG/DIP payment reform has been rolling out across the nation and is projected to fully implement by the end of 2024.
China's DRG system sets 26 MDCs based on the main diagnosis and is divided into 376 ADRGs taking into account both internal and surgical procedures. Based on the above ADRGs, individual DRG group can be set according to actual situations in different regions, usually up to 1000 groups, and the flat or floating rate is calculated for each DRG group. DIP payment, which is Diagnosis-Intervention Packet payment, is an innovative payment method in China. DIP groups are clustered according to disease diagnosis and treatment methods in real world clinical practices. Cases involving more than 15 inpatients can be grouped together as a DIP group and there are typically around 10,000 DIP groups in each city. Each DIP group has a relative weight and payment for each group is a point system under a global budget of health insurance.
DRG/DIP payment reform will have an impact on the behaviour of health care providers, incentivizing hospitals to control costs, but may reduce the use of innovative technologies and drugs which will lead to high costs. Therefore, the long-term effects of this policy need to be tracked and observed.
Advances in India's Healthcare: Health Economics, Digital Health, and Artificial Intelligence
Presented by: Amit Dang, MD, Founder and CEO, MarksMan Healthcare Communications, India
This presentation focused on the advancements in health economics, digital health, and artificial intelligence (AI) in India, emphasizing their transformative potential and the strategic initiatives driving these changes.
The digital healthcare market in India is poised for substantial growth, with a projected CAGR of 21.36%, expected to reach Rs. 882.79 billion by FY 2027. This rapid expansion is fueled by government initiatives like the Ayushman Bharat Digital Mission (ABDM) and strategic partnerships with major tech companies. AI and telemedicine, particularly AI-powered Electronic Medical Records (EMR), are playing a crucial role in revolutionizing healthcare delivery.
The National Health Authority (NHA) of India is at the forefront of implementing the ABDM, aiming to establish a comprehensive digital health ecosystem that benefits clinics, diagnostic centers, hospitals, laboratories, and pharmacies across India. Platforms like eSanjeevani, alongside updated guidelines and reimbursement policies, are fostering continued growth in digital health services.
A 2023 study by the Indian Institute of Management Bangalore and Fortis Healthcare highlighted the cost-saving potential of AI-powered diabetic retinopathy detection, showcasing the efficiency gains made possible by Explainable Artificial Intelligence (XAI). The surge in digital health consultations further underscores this transformation, with a 2022 whitepaper by Apacmed reporting a 750% increase in non-metro cities and a 450% rise in metro cities.
As G20 president in 2023, India emphasized the importance of digital health on the global stage, promoting collaborative efforts to maximize the impact of digital interventions. While the Digital India Bill, 2023, addresses regulations for wearable devices, specific guidelines for AI-powered healthcare solutions are still evolving. Initiatives like NITI Aayog's "AI for Health" program, launched in 2020 in partnership with AIIMS Delhi, are critical in developing and deploying AI-driven healthcare solutions.
Ethical considerations remain a cornerstone in the deployment of AI in healthcare. In 2023, ICMR released ethical guidelines for application of AI in biomedical research and healthcare, stressing the need for data privacy, algorithmic bias, and transparency in decision-making processes. The 2024 Indian budget speech underscored the government’s commitment to increasing investment in AI research and development, aiming to address indigenous healthcare challenges through innovative solutions.
The HTAIn established under the Department of Health Research continues to spearhead the HTA activities in India. The year 2023 saw the development of an India-specific HTA quality appraisal checklist (HTA-QAC). This checklist helps assess the methodological rigor of HTA studies conducted in the Indian context. Further, organizations like ICMR have been conducting continuous and targeted capacity-building workshops and training programs in HTA.
The presentation concluded by emphasizing that the intersection of health economics, digital health, and AI presents immense opportunities for transforming India's healthcare landscape. By harnessing these technologies responsibly and collaboratively, significant improvements in healthcare delivery and outcomes can be achieved.
Health Policy Updates in Singapore
Presented by: Viva Ma, PhD, MBA, Director, Strategic Access, Public Affairs, Greater Asia, BD, Singapore
On March 6, Singapore Health Minister Ong Ye Kung announced the introduction of government subsidies for patients enrolled in the Mobile Inpatient Care @ Home (MIC@Home) program, effective April 1. Under this initiative, patients receiving care at home will benefit from subsidies provided by the Singaporean government, and they will also have the option to utilize national medical saving and insurance schemes such as MediSave and MediShield Life to cover their medical expenses. Launched in 2022, the MIC@Home program enables patients to receive medical treatment from their homes through teleconsultation and home visits by healthcare professionals. Under the subsidized MIC@Home program, patients will be charged for medical services at rates comparable to or lower than those at public hospitals. To support the transition of patients from acute hospitals to community hospitals, diagnostic services such as CT and MRI scans, along with expensive medications, will be subsidized at a rate ranging from 50 to 80 percent, beginning from the final quarter of this year.
In the past year, Singapore Agency for Care Effectiveness (ACE) has started putting together the Implant Subsidy List (ISL). Implants on ISL will be centrally procured and subsidized by Singapore government for use in public hospitals. As of Apr 1, 2024, included in the list, there were 10 clinical functions, 68 product categories, 155 product groups, and 24,576 products on the list. Nine new product groups are planned to be added in 2024 with following schedule.
April 2024
- Aortic implants
- Gastroenterology implants
- Urogenital implants
- Ossicular middle ear implants
August 2024
- Vascular patency and embolic management
- Vascular occlusion, access, and closure implants
- Neurovascular implants
Dec 2024
- Spine implants
- Mammary implants
The Direction of Cost-Effectiveness and Push for Mixed-Billing in Japan
Presented by: Bruce Crawford, General Manager, Vista Health, Tokyo Japan
In April 2024, Japan's Ministry of Finance (MOF) presented a significant proposal to the Fiscal System Council, advocating for major reforms to the current cost-effectiveness analysis (CEA) / health technology assessment (HTA) system for pharmaceuticals. This proposal aimed to influence the government's annual Basic Policy on Economic and Fiscal Management and Reform (honebuto). The MOF's proposal sought to broaden the use of CEAs to inform reimbursement decisions for new drugs, expanding product coverage and the range of price adjustments based on CEA outcomes.
MOF criticized the current system stating that nearly all drugs receive reimbursement regardless of their HTA evaluation, prices for new drugs are currently set without assessing their additional value, and the high-cost medical care expense benefit system reduces patient cost-consciousness. (The high-cost medical care expense benefit can reduce payments based on age and annual income. It further reduces costs if you apply for the high-cost benefit four or more times, thereby limiting the copayment amounts from patients.) The MOF compared the current practice with international practices, citing examples from the UK, Canada, France, and Germany, where CEA results have influenced drug reimbursement and pricing. The proposed implementation strategy involved using CEAs for initial drug listings and subsequent price adjustments, distinguishing between innovative and less cost-effective drugs in pricing, expanding the special mixed-billing scheme, and enhancing the use of private insurance for non-covered medicines.
The final honebuto adopted in June, however, used softer language emphasizing the need for CEA reforms to enhance the pharmaceutical industry's competitiveness. There are still some industry concerns about the future direction MOF will push for.
Japan has also seen proposals to expand the mixed-billing scheme for advanced medical technologies and encouraging the use of private insurance to reduce patients’ financial burden. The mixed-billing system allows patients to receive advanced medical treatments and technologies that are not fully covered by public health insurance. Under the current mixed-billing scheme, patients must pay out-of-pocket for treatments not covered by the national health insurance, limiting access to innovative therapies. The MOF’s proposal aims to broaden this system, allowing a combination of public and private payments for high-cost, novel treatments. This expansion is intended to reduce the financial burden on patients while ensuring access to the latest medical advancements. By encouraging the use of private insurance to supplement public coverage, the MOF hopes to make advanced treatments more accessible without overburdening the national healthcare budget.