BackgroundHealthcare system reform of Sanming city has become a leading healthcare reform model in China. It has developed a rigorous pharmaceutical reform consisted of the Zero Mark-up Drug Policy and the Centralized Procurement of Medicine Policy to bring down drug expenses and total health expenditures. However, despite the credit and much attention have been given to Sanming’s pharmaceutical reform, its impact still remains unclear. Therefore, the purpose of this study was to explore the impact of the pharmaceutical reform of Sanming on both drug and total health expenditures.MethodsInterrupted time series analysis with three segments divided by two intervention points was employed to evaluate the impact of the pharmaceutical reform. Segment 1 was the pre-reform period which captured the baseline information. Segment 2 occurred after the first intervention point when the Zero Mark-up Drug Policy was implemented, whereas Segment 3 was after the implementation of the Centralized Procurement of Medicine Policy. Primary outcomes are outpatient drug expenditure, outpatient total health expenditure, inpatient drug expenditure, and inpatient total health expenditure. Data spanning from May 2012 to May 2014 are included.ResultsBoth drug and total health expenditures exhibited rising trends before any policy was carried out. The launch of Zero Mark-up Drug Policy led to significant instant reductions in levels of outpatient drug expenditure (coefficient = -6,602.99, p<0.01), outpatient total health expenditure (coefficient = -9,958.58, p<0.05), inpatient drug expenditure (coefficient = -7,520.90, p<0.01), and inpatient total health expenditure (coefficient = -16,737, p<0.01). Moreover, the previous upward trends were changed into downward trends for inpatient drug expenditure (coefficient = -2,747.02, p = 0.00) and total health expenditure (coefficient = -3,069.29, p = 0.12). However, after the implementation of Centralized Procurement of Medicine Policy, we observed no significant instant level changes and also, the inpatient drug expenditure (coefficient = 372.95, p = 0.01) and total health expenditure (coefficient = 788.76, p = 0.06) resumed upward trends again.ConclusionsAlthough the pharmaceutical reform could control or reduced drug expenditure and total health expenditure in short term, expenditures gradually resumed growing again and reached or even exceeded their baseline levels of pre-reform period, indicating the effect became weakened or even faded out in long term. In all, the pharmaceutical reform as a whole failed to meet its goal of combating sharp growth of drug and total health expenditure.

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Background The maternal mortality ratio (MMR) is an important indicator of maternal health and socioeconomic development. Although China has experienced a large decline in MMR, substantial disparities across regions are still apparent. This study aims to explore causes of socioeconomic related inequality in MMR at the province-level in China from 2004 to 2016. Methods We collected data from various issues of the China Health Statistics Yearbook, China Statistics Yearbook, and China Population and Employment Statistics Yearbook to construct a longitudinal sample of all provinces in China. We first examined determinants of the MMR using province fixed-effect models, accounted for socioeconomic condition, health resource allocation, and access to health care. We then used the concentration index (CI) to measure MMR inequality and employed the direct decomposition method to estimate the marginal impact of the determinants on the inequality index. Importance of the determinants were compared based on logworth values. Results During our study period, economically more deprived provinces experienced higher MMR than better-off ones. There was no evidence of improved socioeconomic related inequality in MMR. Illiteracy proportion was positively associated with the MMR (p < 0.01). In contrast, prenatal check-up rate (p = 0.05), hospital delivery rate (p < 0.01) and rate of delivery attended by professionals (p = 0.02) were negatively associated with the MMR. We also find that higher maternal health profile creation rate (p < 0.01) was associated with a pro-poor change of MMR inequality. Conclusion Access to healthcare was the most important factor in explaining the persistent MMR inequality in China, followed by socioeconomic condition. We do not find evidence that health resource allocation was a contributing factor.

Since few studies evaluated the impact of the global budget payment system (GBPS) over time, and by expenditure type, this paper aims to evaluate the impact of the GBPS on expenditure of inpatients, and explores how hospitals curb the expenditure in patients with cardiovascular diseases (CVDs) in Shanghai. We built a time series model with the monthly expenditure of CVDs from 2009 to 2012. We evaluated the instant impact and trends impact of the GBPS and analyzed results based on medical expenditure types (e.g., drug, examination, cure, unclassified items), discharge number, and expenditure per capita. We found GBPS instantly dropped the medical expenditure by Chinese Yuan (CNY) 55.71 million (p < 0.001), and decreased the monthly increasing trend by CNY 4.23 million (p = 0.011). The discharge number had 10.4% instant reduction and 225.55 monthly decrease (p = 0.021) while the expenditure per capita experienced fewer changes. Moreover, the expenditure of drug and cure had an instant reduction of CNY 28.31 million and 16.28 million (p < 0.001). In conclusion, we considered the GBPS is an effective solution to control the expenditure of CVDs by decreasing the discharge number, and a focus on the drug and cure expenditures lead to greater spend reduction than other types of expenditures.

Objective This study investigated the cost‐effectiveness of a community‐based colorectal cancer‐screening program (C‐CRCSP) in Shanghai, China, among the residents in the urban, suburban and rural areas. Methods A Markov model was constructed to evaluate the cost‐effectiveness of a 25‐year annual C‐CRCSP including 100 000 populations. Cost‐effectiveness was determined by the incremental cost‐effectiveness ratio (ICER); referring to either life‐years gained, or quality‐adjusted life‐years (QALYs) gained. The threshold was gross domestic product per capita. Univariate and multivariate sensitivity analyses were performed to investigate the influence of compliance, prevalence, technological performance, medical cost and annual cost discount rate (3.5%) on ICER. A probabilistic sensitivity analysis evaluated the probability of the cost‐effectiveness of C‐CRCSP at different maximum acceptable ceiling ratios. Results Compared with no screening, the C‐CRCSP resulted in total gains of 7840 QALYs and 2210 life‐years (LY), at a total cost of CNY 58.54 million; that is, the ICER were CNY 7460/QALYs and CNY 26650/LY. Stratifying by residency, the cumulative gains in QALYs and LY were estimated to be the lowest in the urban populations compared with the rural and suburban populations. The cost for the urban population was 3‐fold and 6‐fold that of the suburban and rural populations. The ICER for QALYs ranged from 2180 (rural) to 16 840 (urban). Conclusion The cost‐effectiveness of a C‐CRCSP in Shanghai was most favorable for the rural population, while the urban population benefits less in terms of QALYs. ICER could be enhanced by measures that increase compliance.

OBJECTIVES: To evaluate the cost-effectiveness of different treatment strategies for metastatic colorectal cancer (mCRC) in the Brazilian public health system (SUS). METHODS: We built a Markov model to analyze costs and impacts of the incorporation of cetuximab (CET) or bevacizumab (BEV) to standard therapy (FOLFOX and FOLFIRI), over a time horizon of 10 years. Depending on KRAS status, the patients were assumed to receive one of these sequential schedules: (1) FOLFOX ® FOLFIRI; (2) FOLFIRI± CET ® FOLFOX + BEV; (3) FOLFIRI + CET or BEV ® FOLFOX; and (4) FOLFIRI + BEV ® FOLFOX + BEV ® Irinotecan ± CET.Efficacy data were derived from randomized clinical trials and treatment costs from price tables issued by the Health Ministry. Sensitivity analyses were undertaken to explore uncertainty. Adoption of infusion pumps was investigated as an alternative strategy. RESULTS: Compared to chemotherapy, the incorporation of the CET and BEV resulted in an incremental effectiveness ranging from 23 to 32 life years, and a considerable cost differences, as total costs ranged from US$ 30,053 to around US$96,020. Strategy 2 resulted in an incremental cost-effectiveness ratio of US$182,617 compared to standard therapy, which far exceeds the pre-specified threshold for cost-effectiveness (U$28,715) considered. Strategies 3 and 4 were dominated by strategy 2 Acquisition of biological agents was the principal driver of the cost difference. Adopting an infusion pump for use at home for 100% of patients could reduce around 45% of the total costs of chemotherapy. CONCLUSIONS: From the SUS perspective, and at current prices, biologic agents are not cost-effective for the treatment of mCRC. Chemotherapy continues to be the most cost-effective approach. Home infusion should be promoted to be the standard of care for Brazilian mCRC-patients.

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