**5. Discussion**

#### **5.1 Transferability within China**

At the end of the first workshop, participants found high value in the MCDA approach toward building a criteria-based decision tool. In particular, they appreciated the experience with the MCDA methodological approach which can be applied to decisions in technology assessment based on predefined requirements.

Yu et al. warned in a recent publication that "if supply-induced demand is not effectively controlled, a universal and uniform social health insurance may be more harmful than beneficial in China" [36]. By substituting the existing fee-for-service design with bundled provider payment policies, there can be more integrated approaches for smaller population groups that exist in China [37]. However, this is only possible, if allocation of funds for outpatient services is made by health-care decision-makers, guided by considerations of equity, access, and efficiency in public healthcare. Tools such as MCDA will improve transparency and consistency in health-care decision-making. Although the decision on the future UEBMI policy will be made on a provincial level, the evaluation tool will assist the decision-makers to go through a set of rational decision considerations (criteria) before selecting the most appropriate option. A consensus process, validated through a pilot testing phase, will provide a high level of legitimacy to the decision-making process.

UEBMI is the insurance system for urban employees. The other insurance options for urban residents (URBMI) or for rural citizens (NRCMS) could use similar tools for further developing their insurance options or to design a merged

#### *Value-Based Evaluation of Chinese Provincial Health Insurance Policy Schemes DOI: http://dx.doi.org/10.5772/intechopen.84373*

insurance policy [38]. However, it should be noted that the three systems vary in terms of financing mechanisms, funding extent, and coverage policies and would require a full adaptation of the model. In addition, the stakeholders involved in the process might differ. For example, consumers or patients could be included as important stakeholders, because URBMI and NRCMS are voluntary systems and not mandatory by employment.

The described methodology could also be transferable to other types of decisions in China, such as which products should be listed or reimbursed, or which of the available alternatives should be purchased [30]. Such an application is presented in another chapter of this book at the example of purchasing off-patent pharmaceuticals in hospitals in Thailand [39]. However, successful adaptation of the methodology for each new type of application requires a thorough process described in **Figure 1** of this report, including preparation, involvement of the decision stakeholders, and phased implementation [33].
