ABSTRACT
BACKGROUND: China carried out a comprehensive drug price reform (CDPR) in 2017 to control the growing expense of drug effectively and reduce the financial burden of inpatients. However, early studies in pilot regions found the heterogeneity in the effectiveness of CDPR from different regions and other negative effects. This study aimed to evaluate the effects of the reform on medical expenses, medical service utilisation and government financial reimbursement for inpatients in economically weaker regions. METHODS: Shihezi was selected as the sample city, and 238,620 inpatients, who were covered by basic medical insurance (BMI) and had complete information from September 2016 to August 2018 in public hospitals, were extracted by cluster sampling. An interrupted series design was used to compare the changing trends in medical expenses, medical service utilisation and reimbursement of BMI for inpatients before and after the reform. RESULTS: Compared with the baseline trends before the CDPR, those after the CDPR were observed with decreased per capita hospitalisation expenses (HE) by ¥301.9 per month (p < 0.001), decreased drug expense (DE) ratio at a rate of 0.32% per month (p < 0.05) and increased ratio of diagnosis and treatment expenses (DTE) at a rate of 0.25% per month (p < 0.01). The number of inpatients in secondary and tertiary hospitals declined by 458 (p < 0.001) and 257 (p < 0.05) per month, respectively. The BMI reimbursement in tertiary hospitals decreased by ¥254.7 per month (p < 0.001). CONCLUSION: The CDPR controlled the increase in medical expenses effectively and adjusted its structure reasonably. However, it also reduced the medical service utilisation of inpatients in secondary and tertiary hospitals and financial reimbursement for inpatients in tertiary hospitals.
Subject(s)
Commerce , Health Care Costs , Health Care Reform/economics , Health Expenditures , Hospitalization/economics , Hospitals, Public/economics , Pharmaceutical Preparations/economics , Aged , China , Cities , Drug Industry/economics , Female , Financing, Government , Humans , Inpatients , Insurance, Health , Male , Middle Aged , Patient Acceptance of Health Care , Residence Characteristics , Socioeconomic Factors , Tertiary Care Centers/economicsABSTRACT
OBJECTIVE:To provide reference for understanding the significance of drug proportion control deeply and future direction of hospital reform. METHODS:The data were collected from the relevant statistical reports of our hospital in August 2016,June and August 2017. The data were analyzed statistically and compared in respects of drug proportion,income,medical cost,ratio of essential medicine types,prescription amount(outpatient and emergency department),utilization rate and utilization density(AUD)of antibiotics in whole hospital,outpatient and emergency department,inpatient department. RESULTS:The drug proportion of our hospital was decreased significantly in Aug. 2017(after drug price reform),which fell by 13.35% from the previous month and 17.58% year-on-year. Hospital revenues were on the rise,which increased by 6.92% from the previous month and 11.45% year-on-year. Outpatient and emergency income was decreased slightly from the previous month(by 2.73%). Inpatient income was increased significantly from the previous month(by 9.76%). Per capita medical cost in outpatient and emergency department were increased,which increased by 4.01% from the previous month and 9.62% year-on-year;per capita medical cost of inpatients were declined,which fell by 0.91% from the previous month and 3.11% year-on-year. The ratio of essential medicine types in the whole hospital was decreased slightly from the previous month but increased by 17.79% year-on-year. Drug amount of outpatient and emergency prescriptions was decreased by 11.34% from the previous month and prescription amount decreased by 9.16% year-on-year. The utilization rate of antibiotics in the whole hospital was decreased by 8.10% from the previous month;AUD was decreased by 3.88% from the previous month and 13.88%year-on-year. CONCLUSIONS:After drug price reform,drug proportion of our hospital is effectively controlled,which has a positive influence on the operation of medical service system and patient medical cost. At the same time,some problems that need to be solved are also exposed,such as increase in per capita medical costs and the decrease in the number of outpatient and emergency patients. So,drug proportion control is only the first step in deepening hospital reform,and the follow-up motivation still needs to be provided continuously through strengthening rational drug use.
ABSTRACT
Objective To study the characteristics and trends of drug price fluctuation in our country in order to provide reference for the governments in evaluating their policy for the macro-control and management of drug price. Methods The drug price fluctuation was empirically analyzed using the ARCH model according to the monthly drug price data from 2011 to 2017. Results The drug price presented a fluctuant increasing trend with an even fluctuation amplitude and frequency, especially after its reform in 2015. The fluctuation of drug price did not show any clustered feature and significant impact on information but a rather strong memory. Conclusion The fluctuation of drug price is relatively stable in our country. The drug price control policy plays a rather effectively role in stabilizing thefluctuation of drug price. It is thus suggested that the governments should bring their role into full play in controlling drug price, regulating drug marketing, and supervising drug price.
