School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
BMJ Glob Health. 2021 Nov;6(11). doi: 10.1136/bmjgh-2021-007089.
To quantify the overall and dynamic effects of the implementation of the zero-mark-up medicines policy on the proportionate revenue generated from medicines, medical services and government subsidies at Chinese tertiary public hospitals.
The revenue data of 136 tertiary public hospitals from 2012 to 2020 and the implementation-time framework of zero-mark-up medicines policy of these hospitals were obtained from the institutional survey of the third-party evaluation of the China Healthcare Improvement Initiative. The study adopted the time-varying difference-in-differences method and combined it with the event study approach to estimate the effects of the zero-mark-up medicines policy.
Following the implementation of the policy, the proportionate medicines revenue decreased by 3.23% (p<0.001); the proportionate medical services revenue increased by 3.48% (p=0.001); and the difference in the proportionate government subsidies revenue was not significant. In the year of implementation, the proportion of revenue generated from medicines decreased by 7.76% (p=0.0148); and that from medical services increased by 8.62% (p=0.0167). The effect of the policy gradually strengthened thereafter. In 2020, the sixth year after some hospitals started the implementation of the policy, the share of revenue generated from medicines decreased the most by 18.43% (p=0.0151), and that generated from medical services increased the most by 15.29% (p=0.0219). The share of revenue generated from government subsidies increased by 2%-5% in the second, third, fifth and sixth years following implementation (p<0.05).
Although the policy goal of adjusting hospital revenue structure has been achieved, the findings were insufficient to conclude whether the policy goal of establishing a scientific compensation mechanism was met by increasing the price of medical services and government input. Additionally, whether there was an unexpected policy effect requires further analysis.
量化中国三级公立医院实施零加成药品政策对药品、医疗服务和政府补贴收入比例的总体和动态影响。
从中国医疗改善行动计划第三方评估机构的机构调查中获取了 136 家三级公立医院 2012 年至 2020 年的收入数据和这些医院零加成药品政策的实施时间框架。研究采用时变差异中的差异方法，并结合事件研究方法来估计零加成药品政策的效果。
政策实施后，药品收入比例下降 3.23%（p<0.001）；医疗服务收入比例上升 3.48%（p=0.001）；政府补贴收入比例差异不显著。在实施当年，药品收入比例下降 7.76%（p=0.0148），医疗服务收入比例上升 8.62%（p=0.0167）。此后，政策效果逐渐增强。在 2020 年，即一些医院开始实施政策的第六年，药品收入比例下降最多，下降了 18.43%（p=0.0151），医疗服务收入比例上升最多，上升了 15.29%（p=0.0219）。实施后第二年、第三年、第五年和第六年，政府补贴收入比例增加了 2%-5%（p<0.05）。
虽然实现了调整医院收入结构的政策目标，但增加医疗服务价格和政府投入以建立科学补偿机制的政策目标是否实现的结论尚不充分。此外，是否存在意外的政策效果还需要进一步分析。
