A retrospective and prospective assessment of the zero‐markup drug reform in China from the perspective of policy diffusion

Deng, Jianwei; Tian, Huilin; Guo, Yilun; Ma, Tengyang; Sun, Yu; Zhang, Shiyang; Yang, Tianan; Tian, Xu

doi:10.1002/hpm.2562

Cited by 25 publications

(22 citation statements)

References 9 publications

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“…Similar to the decreasing trend for availability in the study of essential medicines [48], we noted the decrease in anticancer medicine availability between both time periods. For public hospitals, the sales of medicines accounted for approximately 40% of their revenue [49,50]. Health service providers made higher profits from more costly pharmaceuticals since the mark-up ratio was prescribed by the government.…”

Section: Discussionmentioning

confidence: 99%

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Availability, Price and Affordability of Anticancer Medicines: Evidence from Two Cross-Sectional Surveys in the Jiangsu Province, China

Zhu

Wang

Sun

et al. 2019

IJERPH

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Objectives: With the increasing incidence of cancer, poor access to affordable anticancer medicines has been a serious public health problem in China. To help address this issue, we assessed the availability, price and affordability of pharmacotherapy for cancer in public hospitals in the Jiangsu Province, China. Methods: In 2012 and 2016, anticancer medicine availability and price information in the capital and five other cities was collected. A total of six cancer care hospitals, 26 tertiary general hospitals and 28 secondary general hospitals were sampled, using an adaptation of the World Health Organization/Health Action International methodology. Data was collected for the anticancer medicines in stock at the time of the surveys. Prices were expressed as inflation-adjusted median unit prices (MUPs). Medicine was affordable if the overall cost of all the prescribed anticancer medicines was less than 20% of the household’s capacity to pay. We used generalized estimating equations to estimate the significance of differences in availability from 2012 to 2016 and the Wilcoxon rank test to estimate the significance of differences in MUPs. Multivariate logistic regression was computed to measure predictors of affordability. Results: From 2012 to 2016 there was a significant decrease in the mean availability of originator brands (OBs) (from 7.79% to 5.71%, p = 0.012) and lowest-priced generics (LPGs) (36.29% to 32.67%, p = 0.009). The mean availability of anticancer medicines in secondary general hospitals was significantly lower than the cancer care, as well as in tertiary general hospitals. The MUPs of OBs (difference: −21.29%, p < 0.01) and their LPGs (−22.63%, p < 0.01) decreased significantly from 2012 to 2016. The OBs (16.67%) of all the anticancer medicines were found to be less affordable than LPGs (34.62% for urban residents and 30.77% for rural residents); their affordability varied among the different income regions. From 2012 to 2016, the proportion of LPGs with low availability and low affordability dropped from 30.77% to 19.23% in urban areas and 34.62% to 26.92% in rural areas, respectively. Generic substitution and medicine covered by basic medical insurance are factors facilitating affordability. Conclusion: There were concerning decreases in the availability of anticancer medicines in 2016 from already low availability in 2012. Anticancer medicines were more affordable for the patients in high-income regions than the patients in low-income regions. Governments should consider using their bargaining power to reduce procurement prices and abolish taxes on anticancer medicines. Policy should focus on the special health insurance plan for low-income patients with cancer. The goal of drug policy should ensure that first-line generic drugs are available for cancer patients and preferentially prescribed.

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Section: Discussionmentioning

confidence: 99%

“…On the one hand, the decrease in retail price of the anticancer medicines may have been due to the ‘zero-markup’ policy [49]. Prior to year 2015, a 15% markup policy was implemented in all of the public hospitals in the Jiangsu Province.…”

Section: Discussionmentioning

confidence: 99%

Availability, Price and Affordability of Anticancer Medicines: Evidence from Two Cross-Sectional Surveys in the Jiangsu Province, China

Zhu

Wang

Sun

et al. 2019

IJERPH

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“…It was not until the end of 2018 that the trial of "hierarchical medical system" was launched [52]. Another example, public hospitals have been the focus of the new health reform since 2012, and the " canceling medicine markups" is the main key point, but until 2017, it was fully implemented in public hospitals [53]. Third, a reasonable incentive mechanism should be gradually established during the implementation process to ensure that the new health reform policy can continue to exert its effects and enable the citizens to obtain long-term benefits.…”

Section: Resultsmentioning

confidence: 99%

Evaluation of the Effect of New Health Reform Policy of China Based on Prospect Theory

Guan

Zhe

2020

Preprint

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Background: New health reform policy of China has gone through more than ten years from 2009 to 2019, it has come a critical period. It is important to evaluate the effect of health system reform policy, but there are a few existing studies and the researchers have not considered the impact of psychological factors on person decision-making. This study using the prospect theory can overcome this defect. Let the evaluation of the effect of new medical reform policy of China more scientific and reasonable. Methods: Data on the effect of the new health reform from China Health Statistics Yearbook and National Bureau of Statistics of China were obtained. And the indicators were selected by Corrected Item Total Correlation and Cronbach’s α reliability coefficient. The selected indicator data were calculated by the prospect theory model. Meanwhile the gray relation analysis method is introduced to enlarge the difference between the advantages and disadvantages to making the comprehensive evaluation result more obvious. Results: The results of comprehensive evaluation of the effects of health reform policies in China fluctuated from 2000 to 2017. From 2000 to 2004, the fluctuation range of the comprehensive prospect value is large; from 2004 to 2009, the comprehensive prospect value shows a slow downward trend; from 2009 to 2012, the comprehensive prospect value has decreased slightly, and then it has rebounded substantially; from 2012 to 2014, the comprehensive prospect value is stable; and from 2014 to 2017, the comprehensive prospect value is declining. Conclusions: This study showed that the implementation of new health reform policy of China has a significant impact on China's medical and health system. The new health reform advanced hard in exploration. It is worth affirming that the overall goal and direction of the new health reform are correct, but the practice is unsatisfactory. The releasing and implementation of supporting policy have the important influence on the progress of the new health reform. And the effect of the policy will decrease with the increase of the total amount. Therefore, scientific and effective late management can ensure that the policy continues to play its role.

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“…The proportion of out-of-pocket (OOP) expenditures in total health expenditures decreased from 59.97% in 2001 to 29.27% in 2015. The health care reform policy has got certain achievements and improved residents’ sense of access [ 8 – 10 ].…”

Section: Introductionmentioning

confidence: 99%

Cluster analysis of differences in medical economic burden among residents of different economic levels in Guangdong Province, China

Chen

Qian

et al. 2020

BMC Health Serv Res

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Background This study compares and analyzes the differences of residents’ medical economic burden in different economic levels, explores the factors for improving the equity of health services in Guangdong, China. Methods Cluster analysis was carried out in 20 cities of Guangdong Province by taking 7 key factors on the equity of health services as indicators. Seven key factors were collected from Guangdong Statistical Yearbook 2017 and the Sixth National Population Census. R-type clustering was used to reduce the dimensionality of 7 candidate variables through similarity index. Q-type clustering was used to classify 20 cities in Guangdong Province. Results The cluster analysis divided Guangdong Province into three regions with different medical economic burden. The greater the proportion of the elderly over 65 years old, the greater the proportion of health care expenditure to per capita consumer expenditure of residents, and the heavier the medical economic burden. On average, 10.75% of the general budget expenditure of each city in Guangdong Province is spent on health care. Conclusions The lower per capita GDP, the higher proportion of the elderly over 65 years old and the lack of medical technicians are risk factors for the heavier medical burden of the residents and the fairness of health services. While increasing the health expenditure, the government needs to further complete the reform of the medical and health system, improve the efficiency of the medical system and curb the rapid rise of absolute health expenditures of individuals, which can reduce the economic burden of residents’ medical care.

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A retrospective and prospective assessment of the zero‐markup drug reform in China from the perspective of policy diffusion

Cited by 25 publications

References 9 publications

Availability, Price and Affordability of Anticancer Medicines: Evidence from Two Cross-Sectional Surveys in the Jiangsu Province, China

Availability, Price and Affordability of Anticancer Medicines: Evidence from Two Cross-Sectional Surveys in the Jiangsu Province, China

Evaluation of the Effect of New Health Reform Policy of China Based on Prospect Theory

Cluster analysis of differences in medical economic burden among residents of different economic levels in Guangdong Province, China

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