National School of Development, Peking University; Room 202, National School of Development, Peking University, Beijing, 100871, China.
National School of Development, Peking University; Room 201, National School of Development, Peking University, Beijing, 100871, China.
Soc Sci Med. 2018 Aug;211:114-122. doi: 10.1016/j.socscimed.2018.06.007. Epub 2018 Jun 18.
In 2012, the Chinese government launched a nationwide reform of county-level public hospitals with the goal of controlling the rapid growth of healthcare expenditure. The key components of the reform were the zero markup drug policy (ZMDP), which removed the previously allowed 15% markup for drug sales at public hospitals, and associated increases in fees for medical services. By exploiting the temporal and cross-sectional variations in the policy implementation and using a unique, nationally representative hospital-level dataset in 1880 counties between 2009 and 2014, we find that the policy change led to a reduction in drug expenditures, a rise in expenditures for medical services, and no measurable changes in total health expenditures. However, we also find an increase in expenditures for diagnostic tests/medical consumables at hospitals that had a greater reliance on drug revenues before the reform, which is unintended by policymakers. Further analysis shows that these results were more likely to be driven by the supply side, suggesting that hospitals offset the reductions in drug revenues by increasing the provision of services and products with higher price-cost margins. These findings hold lessons for cost containment policies in both developed and developing countries.
2012 年，中国政府启动了县级公立医院的全国性改革，旨在控制医疗支出的快速增长。改革的关键内容是零差率药品政策（ZMDP），取消了公立医院药品销售此前允许的 15%加价，同时相应提高了医疗服务费用。通过利用政策实施的时间和横截面变化，并利用 2009 年至 2014 年期间全国 1880 个县特有的、具有代表性的医院层面数据集，我们发现政策变化导致药品支出减少，医疗服务支出增加，总卫生支出没有可衡量的变化。然而，我们还发现，在改革前对药品收入依赖程度较高的医院，诊断测试/医疗耗材的支出有所增加，这是政策制定者没有预料到的。进一步的分析表明，这些结果更有可能是由供应方驱动的，这表明医院通过增加提供价格成本利润率更高的服务和产品来抵消药品收入的减少。这些发现为发达国家和发展中国家的成本控制政策提供了借鉴。
