Evaluation of the effectiveness of comprehensive drug price reform: a case study from Shihezi city in Western China


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.

Keywords: Basic medical insurance; Comprehensive drug price reform; Interrupted time-series; Medical expense; Medical service utilisation; Reimbursement.

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The per capita HE ant its composition in the pre- and post-CDPR periods. Note: a Per capita HE. b DE ratio. c DTE ratio. d Reimbursement ratio. Abbreviation: CDPR, comprehensive drug price reform. DE, drug expense. DTE, diagnosis and treatment expense. HE, hospitalization expense. RMB, renminbi, Chinese currency
Fig. 2
Fig. 2
The number of inpatients in the pre- and post-CDPR periods. Note: a Number of inpatients in primary hospitals. b Number of inpatients in secondary hospitals. c Number of inpatients in tertiary hospitals. Abbreviation: CDPR, comprehensive drug price reform
Fig. 3
Fig. 3
The BMI reimbursement in the pre- and post-CDPR periods. Note: a BMI reimbursement in primary hospitals. b BMI reimbursement in secondary hospitals. c BMI reimbursement in tertiary hospitals. Abbreviation: BMI, basic medical insurance. CDPR, comprehensive drug price reform
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