Impacts of the drug markup reduction policy on hospital expenditures of esophageal cancer surgery inpatients in Shanghai, China

Abstract

ObjectivesThis study aims to evaluate the impacts of the drug markup reduction policy (DMRP) on hospital expenditure of esophageal cancer surgery (ECS) inpatients. Study designThis study examined the 2014–2016 individual-level data of patients who underwent ECS in five tertiary hospitals affiliated with the University of Shanghai, China. The patients were divided into three groups based on the proportional markup of the drug they received: 15%, 10%, and 5%. The 15% drug markup group was set as the control group to assess the effect of DMRP on patient spending. MethodsWe compared patient characteristic variables to observe differences among the groups and considered various categories of spending. Absolute growth, relative growth, and overall growth rates were calculated to compare the changes in each type of spending. The rank-sum test and quantile regression were used to assess absolute changes in and the factors influencing total and drug-related expenditure. ResultsWe found that drug spending dropped by 17.01% during this period, to a total of ¥6159.28/patient ($970.91), and drug spending as a proportion of total expenditure fell by 8.90 percentage points to 30.92%. However, total spending during this period increased by 6.88% per patient, with an absolute growth of ¥6259.29/patient ($986.67), while out-of-pocket spending increased by 11.27%, to ¥8093.99/patient ($1278.09). ConclusionsOverall, the reform had positive effects on the drug-related spending of ECS patients, but cost control measures should be strengthened.