Abstract
BackgroundSince 2015, all pilot cities of public hospital reform in China have allowed the zero-markup drug policy and implemented the policy of Separating of Hospital Revenue from Drug Sales (SHRDS). The objective of this study is to evaluate whether SHRDS policy reduces the burden on patients, and to identify the mechanism through which SHRDS policy affects healthcare expenditure.MethodsIn this study, we use large sample data of urban employee’s healthcare insurance in Chengdu, and adopt the difference in difference model (DID) to estimate the impact of the SHRDS policy on total healthcare expenditures and drug expenditure of patients, and to provide empirical evidence for deepening medical and health system reform in China.ResultsAfter the SHRDS policy’s implementation, the total healthcare expenditure kept growing, but the growth rate slowed down between 2014 to 2015. The total healthcare expenditure of patients decreased by only 0.6%, the actual reimbursement expenditure of patients decreased by 4.1%, the reimbursement ratio decreased by 2.6%. and the drugs expenditure dropped by 14.4%. However, the examinations expenditure increased by 18.2%, material expenditure increased significantly by 38.5%, and nursing expenditure increased by 12.7%.ConclusionsAfter implementing the SHRDS policy, the significant reduction in drug expenditure led to more physicians inducing patients’ healthcare service needs, and the increased social healthcare burden was partially transferred to the patients’ personal economic burden through the decline in the reimbursement ratio. The SHRDS policy is not an effective way to control healthcare expenditure.
Highlights
As the economy developed, consumption behavior have undergone great changes
We address three research questions: (1) what is the effect of the Separating of Hospital Revenue from Drug Sales (SHRDS) policy on healthcare expenditure? (2) Does the SHRDS policy really reduce the burden on patients? (3) What is the mechanism through which the SHRDS policy affects healthcare expenditure? We believe that the process of medical and health system reform is a complicated social system engineering, the increase of public medical and health input plays an important role, the improvement of reducing healthcare expenditure, as well as the economic burden on patients are much more vital
In terms of total healthcare expenditure and reimbursement expenditure, we found that the total healthcare, nominal reimbursement, actual reimbursement expenditure and reimbursement ratio increased by 3.8% (e0.038–1, p-value = 0.452), 5.5% (e0.054–1, p-value = 0.375), 14.4% (e0.135–1, p-value = 0.557), and 6.2% (e0.060–1, p-value = 0.187), respectively
Summary
The demand for healthcare is increasing, and the soaring healthcare expenditure has become a global concern for both developing and developed countries [1] This burden is worsened by fastgrowing aging population. Prior to the new round of health care reform in 2009, public medical sectors were allowed to impose a 15% profit margin for drugs sales to compensate for operation costs. In order to solve the problem of health care’s limited access and prohibitive costs (commonly known as kan-bing-nan, kan-binggui in Chinese), the central government officially launched a new round of medical and health system reform in 2009, with the SHRDS policy at the core of the reform, hoping to disentangle hospital revenue from drug sales, to contain the rapid growth of healthcare expenditure, as well as reduce the economic burden, and meet the healthcare needs of the people. The objective of this study is to evaluate whether SHRDS policy reduces the burden on patients, and to identify the mechanism through which SHRDS policy affects healthcare expenditure
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