Zeng Jianying, Chen Xiwen, Fu Hongqiao, Lu Ming, Jian Weiyan
Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, Beijing, China.
Department of Medical Informatics, School of Basic Medicine, Peking University Health Science Center, Beijing, China.
BMC Health Serv Res. 2019 Nov 29;19(1):916. doi: 10.1186/s12913-019-4764-z.
In September 2012, Beijing, the capital of China, selected five tertiary hospitals as pilots to remove the previously allowed 15% markup for drug sales. However, while most research demonstrated the significant decrease in drug sales, the core issue of high health expenditure was not well solved because of the unintended policy impact. This study aimed to empirically evaluate the short-term and long-term unintended impacts on controlling medical expenses of Beijing's zero markup drug policy from 2012 to 2015.
This study extracted 2012-2015 individual-level data from the Beijing Urban Employee Basic Medical Insurance (UEBMI) database and performed a propensity score-matched analysis to evaluate the short-term and long-term impacts on controlling medical expenses. All inpatients in the 5 pilot reform hospitals were selected as the intervention group, while inpatients in other tertiary hospitals were selected as the control group.
A total of 520,996 inpatients were extracted in this study. For patients in the pilot hospitals, the total expenditures per admission decreased from 17,140.3 yuan in 2012 to 15,430.1 yuan in 2013 and then increased to 16,789.8 yuan in 2015. Expenditure on drugs reduced from 5811.7 yuan in 2012 to 3903.4 yuan in 2015. However, a significant substitution effect of medical consumables was first observed in the third quarter of 2014, which undermined the impact of the policy. In the long-term, the intervention group and control group demonstrated the same trend.
After the zero markup drug policy, expenditure on drugs revealed a continuous decline. However, the decline in total expenditure was weakened by the substitution effect of medical consumables in the long term.
2012年9月，中国首都北京选取了5家三级医院作为试点，取消此前允许的15%药品销售加成。然而，尽管大多数研究表明药品销售额显著下降，但由于意外的政策影响，高医疗支出这一核心问题并未得到很好解决。本研究旨在实证评估2012年至2015年北京药品零加成政策对控制医疗费用的短期和长期意外影响。
本研究从北京市城镇职工基本医疗保险（UEBMI）数据库中提取了2012 - 2015年的个体层面数据，并进行倾向得分匹配分析，以评估对控制医疗费用的短期和长期影响。5家试点改革医院的所有住院患者被选为干预组，其他三级医院的住院患者被选为对照组。
本研究共提取了520,996名住院患者的数据。对于试点医院的患者，每次住院的总费用从2012年的17,140.3元降至2013年的15,430.1元，然后在2015年增至16,789.8元。药品费用从2012年的5811.7元降至2015年的3903.4元。然而，2014年第三季度首次观察到医疗耗材的显著替代效应，这削弱了该政策的影响。从长期来看，干预组和对照组呈现相同趋势。
药品零加成政策实施后，药品费用持续下降。然而，从长期来看，总费用的下降因医疗耗材的替代效应而减弱。
