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Value-Based Approaches to Healthcare Systems and Pharmacoeconomics Requirements in Asia

South Korea, Taiwan, Thailand and Japan

  • International Perspectives
  • Healthcare and Pharmacoeconomics in Asia
  • Published:
PharmacoEconomics Aims and scope Submit manuscript

Abstract

Asian healthcare systems are very diverse, representing cultures, political systems and economies from more than 30 countries with varying histories. Despite the diversity in the region, there has been enormous growth in health economics and outcomes research since the beginning of the 21st century. Whilst Japan has seen very limited use of health technology assessment (HTA), South Korea, Taiwan and Thailand have had remarkable success in establishing government agencies for HTA, employing HTA concepts from the UK National Institute for Health and Clinical Excellence (NICE). These three countries are driven by the following common factors: (i) a desire to establish universal healthcare insurance coverage in their respective nations; (ii) the need for rational allocation of scarce resources; (iii) a desire for government to provide leadership in HTA; and (iv) availability of HTA professionals and faculties through international networks. The HTA models introduced by these three countries are both similar to and different from those of HTA agencies in Europe, but might work well as examples for other countries in the region.

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Table I

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Notes

  1. Nursing care insurance provided by the MHLW. The insurance covers those aged >65 years and patients aged >40 years with specific diseases. The premium payment is mandatory for any Japanese aged >40 years. A free-tochoose contract between the insured and a care provider is required in order to benefit from the insurance, which is provided as home-based nursing care. The government pays the care provider based on the flat payment tariff according to clinical needs and grades (six categories) regulated by the MHLW.

  2. A case-mix-based payment system that includes about 2000 categories combining diagnosis with procedures based on the International Classification of Disease, 10th edition (ICD-10). This system became a milestone that changed the fee-for-service policy into flat payment. It was initially applied for inpatient care in the acute phase, but has since been extended to include chronic-phase and outpatient care. The impact for cost containment is, so far, not as much as the government expected (the year-on-year increases of the National Medical Care Expenditure were 1.8% for 2004, 3.2% for 2005, 0% for 2006 and 3.0% for 2007 after the DPC was introduced in 2003).[23]

  3. The Koizumi Cabinet of the LDP (Liberal Democratic Party of Japan) suggested three directions for reform to control soaring healthcare expenditure: (i) initiatives for the prevention of lifestyle-related diseases; (ii) introduction of a new healthcare insurance system for those aged >75 years; and (iii) downsizing nursing hospitals from 380 000 to 150 000 beds by the year 2012 to save Japanese Yen (¥)4 trillion by the year 2025. However, some of the goals for the reform have not been sufficiently attained due to political instability after the Koizumi Cabinet. That is, the new healthcare insurance system for those aged >75 years began in April 2008 and was entitled the ‘medical care system for elderly in the latter stage of life’, but in 2009 the Hatoyama Cabinet, a new administration of the DPJ (Democratic Party of Japan), declared their intent to abolish the new elderly system by 2013 and to implement another plan, called ‘long life medical care system’, which is still under government consideration.[27]

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No sources of funding were used to prepare this article. The author has no conflicts of interest that are directly relevant to the content of this article.

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  1. Japanese Pharmaceutical Manufacturer’s Association (JPMA) Pharmacoeconomics Program, Graduate School of Health Management, Keio University, 4411 Endo, Fujisawa, Kanagawa, 252-0883, Japan

    Isao Kamae

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Kamae, I. Value-Based Approaches to Healthcare Systems and Pharmacoeconomics Requirements in Asia. Pharmacoeconomics 28, 831–838 (2010). https://doi.org/10.2165/11538360-000000000-00000

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