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中国城市公立医院药品和医疗服务价格改革的影响及意外后果。

The impacts and unintended consequences of the nationwide pricing reform for drugs and medical services in the urban public hospitals in China.

机构信息

Shanghai Health Development Research Center, 1477 Beijing West Rd., Shanghai, 200040, China.

School of Data Science, Fudan University, 220 Handan Rd, Shanghai, 200433, China.

出版信息

BMC Health Serv Res. 2020 Nov 23;20(1):1058. doi: 10.1186/s12913-020-05849-4.

Abstract

BACKGROUND

Since 2015, China has been rolling out the pricing reform for drugs and medical services (PRDMS) in the urban public hospitals in order to reduce drug expenditures and to relieve financial burdens of patients. This study aims at evaluating the effectiveness of the reform and investigating its positive impacts and unintended consequences to provide evidence basis for further policy making.

METHODS

The Difference-in-difference (DID) approach was employed to analyze the reform impacts on the 31 provincial administrative areas in China based on data abstracted from China Statistics Yearbooks and China Health Statistics Yearbooks from 2012 to 2018.

RESULTS

The reform resulted in a decrease of 7.59% in drug cost per outpatient visit, a decrease of 5.73% in drug cost per inpatient admission, a decrease of 3.63% in total cost per outpatient visit and an increase of 9.10% in surgery cost per inpatient admission in the intervention group. However, no significant change in examination cost was found. The reduction in the medical cost per inpatient admission was not yet demonstrated, nor was that in the total outpatient/ inpatient expenses. The nationwide pricing reform for drugs and medical services in urban public hospitals (PRDMS-U) in China is demonstrated to be effective in cutting down the drug expenditures. However, the revealed unintended consequences indicate that there are still significant challenges for the reform to reach its ultimate goal of curbing the medical expenditures.

CONCLUSION

We conclude that the pricing reform alone may not be enough to change the profit-driven behavior of medical service providers as the root cause lies in the unchanged incentive scheme for providers in the service delivery. This holds lessons for policy making of other low- and middle-income countries (LMICs) with similar health systems set up in the achievement of Universal Health Coverage (UHC).

摘要

背景

自 2015 年以来,中国一直在城市公立医院推行药品和医疗服务价格改革(PRDMS),以降低药品支出,减轻患者的经济负担。本研究旨在评估改革的效果,并调查其积极影响和意外后果,为进一步制定政策提供证据基础。

方法

基于 2012 年至 2018 年从《中国统计年鉴》和《中国卫生统计年鉴》中提取的数据,采用双重差分(DID)方法分析改革对中国 31 个省级行政区域的影响。

结果

改革使门诊人均药品费用降低 7.59%,住院人均药品费用降低 5.73%,门诊人均总费用降低 3.63%,住院人均手术费用增加 9.10%。然而,检查费用没有显著变化。住院人均医疗费用的降低尚未显现,门诊和住院总费用也未显现。中国城市公立医院药品和医疗服务全国定价改革(PRDMS-U)被证明在降低药品支出方面是有效的。然而,所揭示的意外后果表明,改革要达到遏制医疗支出的最终目标仍面临重大挑战。

结论

我们的结论是,仅仅进行定价改革可能不足以改变医疗机构以利润为导向的行为,因为根本原因在于服务提供方的激励机制没有改变。这为在实现全民健康覆盖(UHC)方面建立类似卫生系统的中低收入国家(LMICs)的政策制定提供了经验教训。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ebb0/7682084/7d9a5e9ad618/12913_2020_5849_Fig1_HTML.jpg

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