Ding Liman, Wu Jing
School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China.
School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China.
Value Health. 2017 Mar;20(3):412-419. doi: 10.1016/j.jval.2016.10.018. Epub 2017 Jan 3.
To evaluate the effects of the National Essential Medicine Policy (NEMP) on outpatient service utilization and expenditure in Tianjin, China.
All government-owned general primary health care centers (PHCs) within the Urban Employee Basic Medical Insurance in Tianjin were involved in the study. Of these, 49 PHCs implemented the NEMP in April 2009, and constituted the intervention group, and the remaining PHCs constituted the control group. Patients who had visited only one of the two groups at least once pre-NEMP (April 2008 to March 2009) and post-NEMP (April 2009 to March 2010) were included in the correspondent group. A difference-in-differences (DID) analysis was used to estimate the impacts adjusting for patients' sociodemographic characteristics and health status. Sensitivity was tested using the propensity score matching method.
A total of 23,362 and 4,148 patients from the intervention and control groups were identified, respectively. The patients in the intervention group were older (63.7 years vs. 58.8 years; P < 0.001) and in worse health status, as indicated by the Quan-Charlson comorbidity index (1.0 vs. 0.7; P < 0.001), than their counterparts in the control group. The DID results controlling for other confounders indicated that the annual outpatient visits, total annual expenditure, drug expenditure, and out-of-pocket expenditure per capita for the intervention group were not significantly different from those of the control group. Propensity score matching-adjusted DID regression models demonstrated similar results.
The China NEMP implementation did not affect the annual outpatient visits, total expenditure, drug expenditure, and out-of-pocket expenditure in the short term and the original policy goals were not met.
评估国家基本药物政策（NEMP）对中国天津市门诊服务利用和支出的影响。
天津市城镇职工基本医疗保险范围内的所有政府办普通基层医疗卫生机构（PHCs）均参与了本研究。其中，49家PHCs于2009年4月实施了NEMP，构成干预组，其余PHCs构成对照组。在NEMP实施前（2008年4月至2009年3月）和实施后（2009年4月至2010年3月）至少到两组中的一组就诊过一次的患者被纳入相应组。采用双重差分（DID）分析来估计调整患者社会人口学特征和健康状况后的影响。使用倾向得分匹配法进行敏感性测试。
分别从干预组和对照组中识别出23362例和4148例患者。干预组患者年龄较大（63.7岁对58.8岁；P<0.001），且根据全查尔森合并症指数显示健康状况较差（1.0对0.7；P<0.001），高于对照组的对应患者。控制其他混杂因素的DID结果表明，干预组的年门诊就诊次数、年度总支出、药品支出和人均自付支出与对照组无显著差异。倾向得分匹配调整后的DID回归模型显示了类似结果。
中国NEMP的实施在短期内未影响年门诊就诊次数、总支出、药品支出和自付支出，未实现原政策目标。
