Huang Yunxiang, Ren Yan, Zhang Yuanjin, Jia Yulong, Li Qianrui, Yao Minghong, Wang Yuning, Mei Fan, Zou Kang, Hu Huangang, Tan Jing, Sun Xin
Institute of Integrated Traditional Chinese and Western Medicine, and Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China.
NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China.
Int J Health Policy Manag. 2025;14:8540. doi: 10.34172/ijhpm.8540. Epub 2025 May 25.
The National Volume-Based Procurement (NVBP), implemented in China in 2019, aims to reduce patients' economic burden by lowering drug prices and promoting the use of NVBP drugs in public hospitals. We evaluated the impact of NVBP on medical expenditures among hypertensive patients, analyzing both the overall impact and variations in policy effects across individual hospitals.
Using medical records from 1.17 million hypertensive patients across 82 hospitals in Tianjin (2017-2021), we conducted an interrupted time series analysis to assess expenditure changes among hypertensive patients for the treatment of hypertension, dyslipidaemia, type 2 diabetes, and chronic ischemic heart disease (IHD). Multilevel model was employed to estimate the overall impact and hospital-specific variations in policy effects.
NVBP implementation significantly reduced per-visit outpatient expenditures among hypertensive patients for the treatment of hypertension (-15.61%), dyslipidaemia (-25.77%), and diabetes (-17.59%) by lowering drug expenditures. Although drug expenditures for chronic IHD decreased, non-drug expenditures increased, leading to no significant change in total expenditures for chronic IHD (-8.97%). For inpatient expenditures, no significant changes in total per-admission expenditures were observed for chronic IHD or diabetes hospitalizations. Drug expenditures for diabetes decreased significantly, but diagnostic expenditures increased, while no significant change was found in chronic IHD drug expenditures. At the individual hospital level, significant variations in policy effects were observed. Despite the overall decrease in outpatient expenditures for the treatment of hypertension, dyslipidaemia, and diabetes, only 45.6%, 67.2%, and 46.3% of hospitals, respectively, showed significant decreases, while the remainder exhibited either non-significant changes or increases.
NVBP effectively reduced outpatient expenditures among hypertensive patients for the treatment of hypertension, dyslipidaemia, and diabetes, suggesting its potential to alleviate patients' economic burdens. However, the increases in non-drug expenditures and substantial variations in policy effects across hospitals highlight a room for further improvement in policy implementation and overall effectiveness.
2019年在中国实施的国家集中带量采购（NVBP）旨在通过降低药品价格和促进公立医院使用NVBP药品来减轻患者的经济负担。我们评估了NVBP对高血压患者医疗支出的影响，分析了总体影响以及各医院政策效果的差异。
利用天津82家医院117万高血压患者的病历（2017 - 2021年），我们进行了中断时间序列分析，以评估高血压患者治疗高血压、血脂异常、2型糖尿病和慢性缺血性心脏病（IHD）的支出变化。采用多层次模型估计总体影响和各医院政策效果的差异。
NVBP的实施通过降低药品支出，显著降低了高血压患者治疗高血压（-15.61%）、血脂异常（-25.77%）和糖尿病（-17.59%）的每次门诊支出。虽然慢性IHD的药品支出有所下降，但非药品支出增加，导致慢性IHD的总支出没有显著变化（-8.97%）。对于住院支出，慢性IHD或糖尿病住院的每次住院总支出没有显著变化。糖尿病的药品支出显著下降，但诊断支出增加，而慢性IHD的药品支出没有显著变化。在个体医院层面，观察到政策效果存在显著差异。尽管治疗高血压、血脂异常和糖尿病的门诊支出总体下降，但分别只有45.6%、67.2%和46.3%的医院显示出显著下降，其余医院则表现为无显著变化或增加。
NVBP有效降低了高血压患者治疗高血压、血脂异常和糖尿病的门诊支出，表明其在减轻患者经济负担方面的潜力。然而，非药品支出的增加以及各医院政策效果的巨大差异凸显了政策实施和总体效果方面仍有进一步改进的空间。
