Wu Yanghaotian, Han Xuemei, Qiu Jingfu
Department of Social Medicine and Health Service Management, School of Public Health, Chongqing Medical University, Chongqing, People's Republic of China.
Department of Social Medicine, School of Public Health, Southwest Medical University, Luzhou, People's Republic of China.
Risk Manag Healthc Policy. 2024 Apr 3;17:777-788. doi: 10.2147/RMHP.S456977. eCollection 2024.
In 2016, an innovative medical pricing reform called zero-markup drug policy (ZMDP) was implemented in selected pilot cities in China, which focuses on curbing the unreasonable growth of medical expenses. This study aimed to evaluate the impacts of ZMDP on medical expenditure of stroke in western China.
The quantitative data of inpatients diagnosed with stroke was extracted from the medical insurance system in 7 tertiary public hospitals. An interrupted time series (ITS) was used to analyze the instantaneous level and long-term trend changes of hospitalization expenses per visit from January 2015 to November 2018.
A total of 22,407 stroke inpatients were extracted. The total hospitalization expense per visit had the highest proportion of 20,000 CNY and above (33.66%). After the ZMDP, the median total hospitalization expense and western medicine expense per visit decreased by 631.74 CNY and 966.35 CNY, respectively ( <0.001). Before the policy, the total hospitalization expense, traditional Chinese medicine (TCM) expense, examination expense, treatment expense, laboratory expense and surgical expense per visit showed upward trends (<0.05), while the anesthesia expense per visit showed a downward trend (<0.001). When the policy was implemented, the anesthesia expense per visit instantaneously increased by 91.70% (<0.001). After the policy, the total hospitalization expense, western medicine expense, TCM expense, treatment expense and surgical expense per visit changed from upward trends to downward trends (<0.05). The anesthesia expense per visit changed from a downward trend to an upward trend (<0.001), and the examination expense per visit maintained an upward trend (=0.005).
The economic burden of stroke inpatients decreased significantly with the implementation of the ZMDP, especially for the drug expenses. The medical service expenses increased significantly, reflecting the improvement in the value of medical staff's technical labor. However, the unexpected increase in the examination expenses was likely to be associated with the unreasonable medical compensation mechanism.
2016年，中国在部分试点城市实施了一项名为药品零加成政策（ZMDP）的创新性医疗定价改革，其重点在于遏制医疗费用的不合理增长。本研究旨在评估药品零加成政策对中国西部中风患者医疗支出的影响。
从7家三级公立医院的医疗保险系统中提取确诊为中风的住院患者的定量数据。采用中断时间序列（ITS）分析2015年1月至2018年11月期间每次住院费用的即时水平和长期趋势变化。
共提取了22407例中风住院患者。每次住院总费用中20000元及以上的比例最高（33.66%）。实施药品零加成政策后，每次住院的总住院费用中位数和西药费用分别下降了631.74元和966.35元（<0.001）。政策实施前，每次住院的总住院费用、中药费用、检查费用、治疗费用、化验费用和手术费用呈上升趋势（<0.05），而每次住院的麻醉费用呈下降趋势（<0.001）。政策实施时，每次住院的麻醉费用即时增加了91.70%（<0.001）。政策实施后，每次住院的总住院费用、西药费用、中药费用、治疗费用和手术费用从上升趋势转变为下降趋势（<0.05）。每次住院的麻醉费用从下降趋势转变为上升趋势（<0.001），每次住院的检查费用保持上升趋势（=0.005）。
随着药品零加成政策的实施，中风住院患者的经济负担显著减轻，尤其是药品费用。医疗服务费用显著增加，反映了医务人员技术劳动价值的提高。然而，检查费用意外增加可能与不合理的医疗补偿机制有关。
