Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 Wen Hua Xi Lu, Lixia District, Jinan, 250012, China.
NHC Key Lab of Health Economics and Policy Research, Shandong University, No. 44 Wen Hua Xi Lu, Lixia District, Jinan, 250012, China.
Int J Equity Health. 2020 Dec 10;19(1):219. doi: 10.1186/s12939-020-01326-w.
As a key part of the new round of health reform, the zero-markup drug policy (ZMDP) removed the profit margins of drug sales at public health care facilities, and had some effects to the operation of these institutions. This study aims to assess whether the ZMDP has different impacts between county general and traditional Chinese medicine (TCM) hospitals.
We obtained longitudinal data from all county general and TCM hospitals of Shandong province in 2007-2017. We used difference-in-difference (DID) method to identify the overall and dynamic effects of the ZMDP.
On average, after the implementation of the ZMDP, the share of revenue from medicine sales reduced by 16.47 and 10.42%, the revenue from medicine sales reduced by 24.04 and 11.58%, in county general and TCM hospitals, respectively. The gross revenue reduced by 5.07% in county general hospitals. The number of annual outpatient visits reduced by 11.22% in county TCM hospitals. Government subsidies increased by 199.22 and 89.3% in county general and TCM hospitals, respectively. The ZMDP reform was not significantly associated with the revenue and expenditure surplus, the number of annual outpatient visits and the number of annual inpatient visits in county general hospitals, the gross revenue, the revenue and expenditure surplus and the number of annual inpatient visits in county TCM hospitals. In terms of dynamic effects, the share of revenue from medicine sales, revenue from medicine sales, and gross revenue decreased by 20.20, 32.58 and 6.08% respectively, and up to 28.53, 63.89 and 17.94% after adoption, while government subsidies increased by around 170 to 200% in county general hospitals. The number of annual outpatient visits decreased by 9.70% and up to 18.84% in county TCM hospitals.
The ZMDP achieved its some initial goals of removing the profits from western medicines in county hospitals' revenue without disrupting the normal operation, and had different impacts between county general and TCM hospitals. Meanwhile, some unintended consequences were also recognized through the analysis, such as the decline of the utilization of the TCM.
作为新一轮医改的重要内容，零差率药品政策（ZMDP）取消了公立医疗机构药品销售的利润空间，对这些机构的运营产生了一定的影响。本研究旨在评估 ZMDP 对县级综合医院和中医院的影响是否存在差异。
我们从山东省所有县级综合医院和中医院 2007-2017 年的纵向数据中获取了数据。我们使用了差分法（DID）来确定 ZMDP 的总体和动态影响。
平均而言，实施 ZMDP 后，县级综合医院和中医院的药品销售收入占比分别下降了 16.47%和 10.42%，药品销售收入分别下降了 24.04%和 11.58%。县级综合医院的总收入减少了 5.07%。县级中医院的年门诊量减少了 11.22%。县级综合医院和中医院的政府补贴分别增加了 199.22%和 89.3%。ZMDP 改革与县级综合医院的收支结余、年门诊量和年住院量、总收入、收支结余和年住院量均无显著相关性，与县级中医院的总收入、收支结余和年住院量也无显著相关性。就动态影响而言，药品销售收入占比、药品销售收入和总收入分别下降了 20.20%、32.58%和 6.08%，实施后分别下降了 28.53%、63.89%和 17.94%，而政府补贴则增加了 170%至 200%。县级中医院的年门诊量下降了 9.70%，达到了 18.84%。
ZMDP 实现了其在不扰乱正常运营的情况下从县级医院收入中去除西药利润的部分初始目标，并对县级综合医院和中医院产生了不同的影响。同时，通过分析也认识到了一些意想不到的后果，如中医药利用率的下降。
