Effect of separating drug sales from medical services on hospital revenue and medical services in the county public hospitals of Guangxi Province / 中国卫生政策研究

ABSTRACT

Objective:To evaluate the effect of separating drug sales from medical services on hospital revenue and medical services in the county-level public hospitals of Guangxi. Methods:The controlled before and after study design was employed. 2009 to 2012 was the pre-intervention period;2013 was the intervention period. Pilot people’s hospitals were included in the intervention group;non-pilot people’s hospitals were included in the control group. Da-ta came from hospitals and new rural cooperative medical statistics from 2009 to 2013 and the Guangxi Statistical Yearbook from 2010 to 2014. The analysis method of difference-in-differences based regression was employed. Re-sultsSeparating drug sales from medical services included cancelling medicine markups, increasing price of inspec-tion and nursing services, reducing price of large equipment inspection services and increasing financial assistance. In terms of hospital revenue, compared with non-pilot hospitals, for pilot hospitals, the reform reduced medicine rev-enues by 3. 326 million yuan and increased medical revenue by 10. 75 million yuan. There was no significant change in financial assistance. In terms of medical expenses, compared with non-pilot hospitals, the reform reduced per-visit outpatient drug expenses in pilot hospitals by 3. 51 yuan, increased per-visit outpatient inspection fees by 2. 23 yuan, reduced per-visit inpatient drug expenses by 133. 5 yuan, increased per-visit inpatient inspection fees by 62. 01 yuan, and increased per-visit inpatient nursing fees by 69. 72 yuan. There were no significant change in outpatient and inpa-tient visits, length of stay, outpatient expenses per-visit and inpatient expenses per-visit. Conclusion:County hospi-tals can offset losses due to cancelling medicine markups by medical service pricing adjustment in inpatient departments;in outpatient departments, they can offset losses due to cancelling medicine markups by both medical service pricing ad-justments and medical service utilization adjustments beyond policy adjustments. The reform did not reduce the operating revenue of pilot hospitals or the medical expenses per visit. The reform had little effect on hospital and doctor incentives.