Abstract
BackgroundUniversal Zero-Markup Drug Policy (UZMDP) mandates no price mark-ups on any drug dispensed by a healthcare institution, and covers the medicines not included in the China’s National Essential Medicine System. Five tertiary hospitals in Beijing, China implemented UZMDP in 2012. Its impacts on these hospitals are unknown. We described the effects of UZMDP on a participating hospital, Jishuitan Hospital, Beijing, China (JST).MethodsThis retrospective longitudinal study examined the hospital-level data of JST and city-level data of tertiary hospitals of Beijing, China (BJT) 2009–2015. Rank-sum tests and join-point regression analyses were used to assess absolute changes and differences in trends, respectively.ResultsIn absolute terms, after the UZDMP implementation, there were increased annual patient-visits and decreased ratios of medicine-to-healthcare-charges (RMOH) in JST outpatient and inpatient services; however, in outpatient service, physician work-days decreased and physician-workload and inflation-adjusted per-visit healthcare charges increased, while the inpatient physician work-days increased and inpatient mortality-rate reduced. Interestingly, the decreasing trend in inpatient mortality-rate was neutralized after UZDMP implementation. Compared with BJT and under influence of UZDMP, JST outpatient and inpatient services both had increasing trends in annual patient-visits (annual percentage changes[APC] = 8.1% and 6.5%, respectively) and decreasing trends in RMOH (APC = -4.3% and -5.4%, respectively), while JST outpatient services had increasing trend in inflation-adjusted per-visit healthcare charges (APC = 3.4%) and JST inpatient service had decreasing trend in inflation-adjusted per-visit medicine-charges (APC = -5.2%).ConclusionImplementation of UZMDP seems to increase annual patient-visits, reduce RMOH and have different impacts on outpatient and inpatient services in a Chinese urban tertiary hospital.
Highlights
China initiated a huge and complex health reform including the National Essential Medicine System (NEMS, called national essential medicine policy) in 2009.[1]
The NEMS mandated that government-owned healthcare institutions must sell essential medicines with no mark-ups.[2]
Studies have shown that implementation of the NEMS reduced retail medicine-prices and availability of some medicines. [2,3,4,5,6] Not surprisingly, the data from Jiangxi and Shaanxi provinces and nation-level data of all provinces show that the NEMS, the ZMDP for essential medicines, led to significant reduction in per-visit medicine charges in rural areas. [3, 4, 7] Additional effects are physician prescription-pattern changes and differences in medicine prices between urban and rural healthcare institutions.[1, 2, 8]
Summary
China initiated a huge and complex health reform including the National Essential Medicine System (NEMS, called national essential medicine policy) in 2009.[1]. [3, 4, 7] Additional effects are physician prescription-pattern changes and differences in medicine prices between urban and rural healthcare institutions.[1, 2, 8] the increase or decrease of the medicine or healthcare charges was largely dependently on the hospital levels as Wang et al showed.[9] they found that both outpatient and inpatient charges were reduced in township health centers, but increased in the hospitals of county levels or above. It would be interesting to explore the effects of ZMDP on the annual inpatient- and outpatient-visit volumes in urban tertiary hospitals. Universal Zero-Markup Drug Policy (UZMDP) mandates no price mark-ups on any drug dispensed by a healthcare institution, and covers the medicines not included in the China’s National Essential Medicine System. We described the effects of UZMDP on a participating hospital, Jishuitan Hospital, Beijing, China (JST)
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