College of Health Management, China Medical University, Shenyang, Liaoning, China.
Liaoning Province Center for Disease Control and Prevention, Shenyang, Liaoning, China.
J Glob Health. 2021 Sep 30;11:08007. doi: 10.7189/jogh.11.08007. eCollection 2021.
China is facing a more severe stroke challenge. In 2017, China fully implemented the zero-margin drug policy (ZMDP), cancelling 15% of drug markups in public hospitals. Based on the "System of Health Accounts 2011" (SHA 2011), this paper explores the changes in the economic burden of stroke in China after implementing ZMDP to provide an accurate reference for policymakers.
Stroke patients from 2016 to 2018 were selected by multistage stratification probability-proportional random sampling in Shanxi Province. A total of 223 187 samples were included. Regression discontinuity design (RDD) was used to measure the change of drug proportion and cost. Sensitivity analysis and subgroup analysis were implied to determine the stability of the results.
The current curative expenditure on stroke from 2016 to 2018 was 4374.69, 3727.22, and 3752.52 million Chinese Yuan (CNY). About 90% of the cost occurred during hospitalization, and 60% in general hospitals. After the implementation of ZMDP, the drug proportion from 46.54% (interquartile range (IQR) = 37.10%, 55.14%) in 2016 to 36.40% (IQR = 25.82%, 48.58%) in 2018, and average hospitalization cost per stay was from 7950.02 (IQR = 4938.76, 12 639.90) CNY in 2016 to 7362.08 (IQR = 4892.82, 11 501.40) CNY in 2018. RDD showed the drug proportion decreased by 2.76% (95% confidence interval (CI) = 1.17%, 4.35%, = 0.001), and the expense decreased by 4698.34 (95% CI = 3047.59, 6349.09, < 0.001) CNY.
The economic burden of stroke patients in China was severe. ZMDP played a noticeable effect in reducing drug proportion and hospitalization costs. The Chinese government should continue to implement relevant policies to control stroke costs according to regional and population characteristics.
中国正面临着更为严峻的卒中挑战。2017 年，中国全面实施零加成药物政策（ZMDP），取消了公立医院药品加成的 15%。本研究基于“2011 年卫生核算体系”（SHA 2011），旨在探讨 ZMDP 实施后中国卒中经济负担的变化，为决策者提供准确的参考。
采用多阶段分层概率比例随机抽样方法，在山西省选取 2016-2018 年卒中患者，共纳入 223187 例样本。采用回归不连续性设计（RDD）来衡量药物比例和费用的变化。同时进行敏感性分析和亚组分析，以确定结果的稳定性。
2016-2018 年卒中患者的当前治疗支出分别为 4374.69、3727.22 和 3752.52 亿元人民币（CNY）。约 90%的费用发生在住院期间，60%发生在综合医院。ZMDP 实施后，药物比例从 2016 年的 46.54%（四分位距（IQR）=37.10%，55.14%）降至 2018 年的 36.40%（IQR=25.82%，48.58%），平均住院费用从 2016 年的 7950.02（IQR=4938.76，12639.90）CNY 降至 2018 年的 7362.08（IQR=4892.82，11501.40）CNY。RDD 显示，药物比例下降了 2.76%（95%置信区间（CI）=1.17%，4.35%， =0.001），费用下降了 4698.34（95% CI=3047.59，6349.09， <0.001）CNY。
中国卒中患者的经济负担沉重。ZMDP 在降低药物比例和住院费用方面发挥了显著作用。中国政府应根据地区和人口特征，继续实施相关政策，以控制卒中成本。
