Transcript Gabriel Leung, Professor, School of Public Health, Li Ka Shing

Health Policy Networks:
Greater China within East Asia
Gabriel M Leung
School of Public Health
Li Ka Shing Faculty of Medicine
The University of Hong Kong
Region-wide Contextual Challenges
• Epidemiologic stage specific disease patterns: endocrine-related
vs infection-related vs lifestyle-related cancers; diabetes;
gastrointestinal conditions; tropical neglected diseases in
addition to the big 3 (TB, HIV, malaria)
• East Asia in general does not have a formal tradition of relying
on evidence to make decisions
– Partly because gov’t has no teeth as health care is mostly privately
provided in many developing countries
– Partly because there has been little public demand
– Partly because the capacity to generate or even use evidence has
been lacking
– In more advanced economies in the region (TW, SK, JP) with social
insurance, this can possibly be effected through technology
assessment, standardised fee schedules or drug formularies but
strong physician/provider lobby (eg Takemi legacy)
– How can an Observatory, albeit supported by supranational
agencies and sponsors, generate interest and buy-in from national
gov’ts, vested interests, and the general public?
Regional Heterogeneity
• Within region/between countries
– even after stratification by GDP because of different
epidemiology and health system characteristics
– health system typologies (HK: tax-financed with significant
private penetration; CN: rural/urban divide, coop schemes, SHI,
private OOP, etc; TW: SHI)
– epidemiology (double burden) and health system development
don’t move in tandem especially in rapidly transitioning
economies
– political boundaries and the issue of inclusiveness
• Within country/small area variations
– east (coastal) vs west (rural inland) CN
– north vs south in TW
• Regrouping of countries/territories based on dimensions
other than geo-politics to achieve meaningful commonality
Role of regional sentinel hubs or
“sub-observatories”
• “Harbinger” population with similar geo-ethnic
characteristics – HK or TW for mainland CN
• Cross-cutting leverage with other non-health
supranational initiatives
– substantive for cognate areas and
opportunistic/logistic otherwise
• How could observatories or networks of sentinel
hubs best engage existing pockets of expertise
and align them in parallel to working with
governmental agencies and with each other?
– Where do the funds come from?
Functional role
Standard analyses using validated
algorithms for day-to-day operations
Legend
Regional or sub-regional cluster of public health
research observatories with clear differentiation of role
to leverage economies of scope and scale. Size of circle
corresponds to scale of operation.
External links with overseas centers of excellence
Public health
surveillance
Value-added public
health research
Statistical epidemiology
Mathematical biology
Population ecology
Operations research
Geographic information
system
Physical engineering
Public health
decision and
action
Original
insights and
innovations
disseminated in
the medical
and scientific
literature
Impact on
health and
other
externalities
associated
with
infectious
diseases
External Evidence (generated through
regional networks) and Domestic Policy
• Challenge of translational researchers/practitioners –
little good comes of best, current evidence unless it is
implemented expeditiously and effectively
• “Harvard Report” jolted HK out of decades of health
policy benign neglect in 1999
1999
Chronological year
2000
2001
2002
2003
2004
DHA1 (Harvard consultancy)
external input
(IPS/IHP)
DHA2 (HKU)
2005
2006
2007
local capacity
DHA3 (HKU)
2004/05
2003/04
2002/03
2001/02
2000/01
1999/00
1998/99
1997/98
1996/97
1995/96
1994/95
1993/94
1992/93
1991/92
1990/91
1989/90
Fiscal year coverage
Total expenditure on health as a % of GDP
15
Base case
Exemplar scenarios
Harvard projection
0
5
10
Demographic effects only
2005
2010
2015
2020
2025
2030
2035
Year
Cumulative proportion of income
100
80
60
40
20
Lorenz curve of original income
Concentration curve of final income
0
0
20
40
60
80
Cumulative proportion of households ranked by original income (%)
100
• EQUITAP collaboration
• HK assisting with CN’s
Green Paper
• NHA joint data collection
exercise – HK coordinates
and acts as resource for
TW and CN, and beyond in
the region generally
• HK Health sector reform
2008
Critical Success Factors
• Open, transparent process of engagement between
equals
• Multidirectional sharing of different skills
• Competent, independent country partners trusted by
their own gov’ts
• Mutually rewarding
• Properly resourced enterprise
• Start with concrete projects (as opposed to grandiose
visions) and build rapport and capacity (scale and
scope) incrementally
• Long term time horizon for payback