Editorial: Innovative value-based medicine: lessons from China's healthcare evolution

Abstract

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Healthcare systems face a dual challenge of ensuring access to innovations while preserving financial sustainability, giving rise to value-based medicine (VBM), which balances clinical benefit and cost to optimize population health outcomes (1). Additionally, VBM aligns incentives among payers, providers, and patients by emphasizing outcomes, efficiency, and sustainability (1).

China offers a compelling case study in the global evolution of VBM (Table 1). Over the past decade, China has piloted strategies to balance innovation with sustainable financing, including reforms in hospital governance (2), introduction of novel drug payment mechanisms (2), and broader adoption of big data and artificial intelligence (AI) for monitoring costs and clinical outcomes. (3) These reforms highlight how large health systems apply VBM under demographic change, chronic disease growth, and equity demands.

A central element of China's VBM is transparent drug pricing and reimbursement negotiations. Through the National Reimbursement Drug List (NRDL) (4), bulk purchasing has made high-cost drugs more accessible. Simultaneously, payment reforms such as the Diagnosis-Intervention Packet (DIP) system (5) bundle payments to limit unnecessary use and improve efficiency. These reforms reflect a shift away from volume-based incentives and toward structures that prioritize clinical effectiveness and sustainability.

Another frontier of innovation in VBM is the incorporation of technology-driven insights. China's experience with electronic health records, big data, and AI illustrates the potential of digital infrastructure to support outcome measurement, identify inefficiencies, and forecast future healthcare needs. These tools enable more precise, equitable, and sustainable care. For instance, AI-powered models can stratify patients by risk and guide resource allocation, ensuring that interventions generate the greatest health return per unit cost (3).

China's experience reflects global debates on sustainable healthcare financing: high-income countries face the rising costs of biologics and gene therapies, while low- and middle-income nations struggle to expand access without straining budgets. Value-based approaches offer a common framework by linking innovation, outcomes, and affordability.

This Research Topic adds valuable evidence from China, spanning hospital governance, drug pricing, supply chains, and oncology cost-effectiveness, highlighting both the promise and complexity of implementing VBM. Collectively, these studies provide a roadmap for policymakers and clinicians to balance innovation and sustainability in China and beyond.

Zhao et al. examined determinants of physicians' willingness to provide preventive services and found that intentions are shaped by norms and capacity, implying that supportive environments and digital technologies can strengthen sustainable, value-based health systems.

Chen et al. analyzed Diagnosis-Related Groups (DRG) reform effects on lumbar disc herniation patients, and found reduced hospitalization and drug costs. This study suggests that to advance VBM, payment reforms must better align with Traditional Chinese Medicine (TCM) treatment characteristics and outcome-based incentives.

Jiang et al. used interrupted time series analysis of Guangdong's insulin procurement data and found that China's National Volume-Based Procurement (NVBP) policy significantly increased insulin use while reducing total spending and unit costs. These results suggest that centralized procurement can enhance VBM by improving affordability and access without compromising treatment availability.

Xu Y. et al. established a multicriteria decision analysis framework for evaluating implantable medical devices in China, and they found that clinical safety and cost were the most influential criteria, highlighting the framework's potential to promote transparent, VBM allocation.

Wu et al. assessed the service capacity of public hospitals and found that while overall service capacity improved, disparities between hospitals widened, mainly due to inter-group differences. The authors suggest strengthening coordination, optimizing resource allocation, and improving performance evaluation to promote more balanced, value-based hospital development.

Li found that China's Marketing Authorization Holder system significantly improved pharmaceutical firms' environmental, social, and corporate governance performance by boosting investment and reducing internal inequality, supporting more sustainable, value-based industry development.

Tao et al. analyzed data from 264 hospitals and found that China's DIP reform significantly reduced hospitalization costs and length of stay for coronary heart disease patients. However, differences in out-of-pocket ratios between insurance types highlight the need to balance efficiency gains with equity in value-based payment reforms.

Chang et al. conducted qualitative interviews and found leadership support and clear guidelines that facilitated DIP reform, while resource constraints and staff resistance hindered their adoption. The study recommends strengthening internal management, communication, and staff training, underscoring that successful VBM reform requires organizational readiness and adaptive capacity alongside policy design.

Liu et al. assessed the digital economy's impact on resilience and found that digitalization strengthens resilience by reducing trade dependence, increasing export complexity, and lowering concentration. The study illustrates how digital infrastructure supports continuity of care and economic stability, extending VBM to the domain of global supply chain sustainability.

Xu H. et al. evaluated DIP reform's impact on costs for hematologic malignancies (HM). While overall costs decreased, HM treatments remained above reimbursement standards. This underscores the need to refine payment standards to reflect clinical complexity and resource intensity, ensuring departments remain financially viable.

Additionally, Zhang H. et al., Wang et al., Hong et al., and Yang et al. conducted cost-effectiveness analyses of oncology, immunotherapy, and pharmaceutical interventions, showing that clinical benefits often depend on price levels and reimbursement thresholds, underscoring the importance of price negotiation for realizing value. Zuo et al. demonstrated that cross-border knee replacement care achieved lower costs through shorter length of stay, highlighting efficiency gains from system integration. Guanyi et al. found that excessive buyer market power may suppress pharmaceutical profitability, suggesting the need to balance affordability with innovation incentives. Zhang X. et al. showed that integrating internet hospitals into medical alliances can improve referral efficiency and stakeholder value under appropriate cost-sharing arrangements, supporting value-based care by optimizing resource allocation and access across healthcare tiers.

Conclusion

These studies show how China's healthcare reforms serve as laboratories for value-based models and illustrate the diverse domains where VBM principles apply. Key lessons include the need for equity-sensitive design, the role of technology in resilience, and the importance of aligning pricing and reimbursement with clinical and economic realities.

As health systems worldwide face rising costs and unequal access, these findings stress that value-based medicine is not monolithic but a flexible, context-sensitive paradigm. Integrating lessons from China with global best practices can help build systems that are innovative, equitable, and sustainable.