Abstract
BackgroundChina carried out a comprehensive drug price reform (CDPR) in 2017 to control the growing expense of drug effectively and reduce the financial burden of inpatients. However, early studies in pilot regions found the heterogeneity in the effectiveness of CDPR from different regions and other negative effects. This study aimed to evaluate the effects of the reform on medical expenses, medical service utilisation and government financial reimbursement for inpatients in economically weaker regions.MethodsShihezi was selected as the sample city, and 238,620 inpatients, who were covered by basic medical insurance (BMI) and had complete information from September 2016 to August 2018 in public hospitals, were extracted by cluster sampling. An interrupted series design was used to compare the changing trends in medical expenses, medical service utilisation and reimbursement of BMI for inpatients before and after the reform.ResultsCompared with the baseline trends before the CDPR, those after the CDPR were observed with decreased per capita hospitalisation expenses (HE) by ¥301.9 per month (p < 0.001), decreased drug expense (DE) ratio at a rate of 0.32% per month (p < 0.05) and increased ratio of diagnosis and treatment expenses (DTE) at a rate of 0.25% per month (p < 0.01). The number of inpatients in secondary and tertiary hospitals declined by 458 (p < 0.001) and 257 (p < 0.05) per month, respectively. The BMI reimbursement in tertiary hospitals decreased by ¥254.7 per month (p < 0.001).ConclusionThe CDPR controlled the increase in medical expenses effectively and adjusted its structure reasonably. However, it also reduced the medical service utilisation of inpatients in secondary and tertiary hospitals and financial reimbursement for inpatients in tertiary hospitals.
Highlights
The rapid increase in drug price puts considerable strain on the affordability and sustainability of healthcare spending [1, 2]
In view of the positive and negative effects of early drug price reforms in the pilot regions and the heterogeneity in the effects of comprehensive drug price reform (CDPR) from different regions, the objective of the current study is to evaluate the effectiveness of CDPR through the changing trends in medical expenses, medical service utilisation and government financial reimbursement for inpatients before and after the CDPR in Shihezi
interrupted time series analysis (ITSA) results of medical expenses and its compositions In the pre-CDPR period, evident growth trends were observed in per capita hospitalisation expenses (HE) (¥124.2 per month; 95% CI = 52.8 to 195.6, p < 0.01), and the drug expense (DE) and diagnosis and treatment expenses (DTE) ratios remained unchanged
Summary
The rapid increase in drug price puts considerable strain on the affordability and sustainability of healthcare spending [1, 2]. The purpose is to reduce the financial burden of inpatients and guide the patients to rationally choose a hospital according to their health status [15]. It has not limited the patients’ behaviour for seeking healthcare service [16], so a large number of patients seeking high-quality medical service bypass primary hospitals to visit secondary and tertiary hospitals, thereby increasing unnecessary medical expenses [17]. China carried out a comprehensive drug price reform (CDPR) in 2017 to control the growing expense of drug effectively and reduce the financial burden of inpatients. This study aimed to evaluate the effects of the reform on medical expenses, medical service utilisation and government financial reimbursement for inpatients in economically weaker regions
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