Effects of County Public Hospital Reform on Procurement Costs and Volume of Antibiotics: A Quasi-Natural Experiment in Hubei Province, China

Abstract

BackgroundThe overuse of antibiotics has become a major public health challenge worldwide, especially in low- and middle-income countries, including China. In 2009, the Chinese government launched a series of measures to de-incentivise over-prescription in public health facilities, including decoupling the link between facility income and the sale of medicines.ObjectivesWe evaluated the effects of these measures on procurement costs and the volume of antibiotics in county public hospitals.MethodsThe study was undertaken in the Hubei province of China, where 64 county public hospitals implemented the reform in sequence at three different stages. A quasi-natural experiment design was employed. We performed generalised linear regressions with a difference-in-differences approach using 22,713 procurement records of antibiotics from November 2014 to December 2016.ResultsThe regression results showed that the reform contributed to a 14.79% increase in total costs for antibiotics (p = 0.013), particularly costs for injectable antibiotics (p = 0.022) and first-line antibiotics (p = 0.030). The procurement prices for antibiotics remained largely comparable to those in the control group, but the reform led to a 17.30% increase in the procurement volume (expressed as defined daily doses) of second-line antibiotics (p = 0.032).ConclusionsCounty public hospitals procured more antibiotics and greater numbers of expensive antibiotics, such as those administered via injection, to compensate for the loss of income from the sale of medicines, leading to an increased total cost of antibiotics.Electronic supplementary materialThe online version of this article (10.1007/s40273-018-0654-1) contains supplementary material, which is available to authorized users.

The Effects of County Public Hospital Reform on the Consumption and Costs of Antibiotics: Evidence from a Quasinatural Experiment in Jiangsu, China

“…The indicator “average costs per DDD” could also be regarded as the unit price for drugs. For instance, the similar indicators, such as “costs per DDD” and “average unit price per DDD,” were used in some drug utilization studies [ 16 , 49 ]. If a hospital was found to have higher average costs per DDD than another hospital, it indicated that the drugs in the hospital were much more expensive than another hospital.…”

“…It is commonly recognized that the root of overprescription of antibiotics in China is the distorted pricing schedule propelled by the market-oriented economic reforms in the 1980s [ 16 ]. The government changed the financial subsidy system for public hospitals in the transition period of economic reform, which led to a reduction in the state financing.…”

“…Generally, a number of studies have focused on the effects of county public hospital reform on price and costs of medicines, healthcare quality, and the operating efficiency. Only one study evaluated the impact of the county public hospital reform on procurement volume and cost of antibiotics in Hubei Province, Central China [ 16 ]. The study demonstrated that county public hospital reform actually led to an increased total cost of antibiotics due to compensation for the loss of income from the drug sales [ 16 ].…”

“…Only one study evaluated the impact of the county public hospital reform on procurement volume and cost of antibiotics in Hubei Province, Central China [ 16 ]. The study demonstrated that county public hospital reform actually led to an increased total cost of antibiotics due to compensation for the loss of income from the drug sales [ 16 ]. However, the findings of the impacts of reform on county public hospitals in different regions have been mixed.…”

Sino-Australian University Partnership in Health Management Education

“…This is evidenced by 11 monographs/textbooks and an impressive 173 peer-reviewed publications produced by the CHP staff about the Chinese health system and health reforms published in both English and the Chinese language. Topics have included patient satisfaction (29)(30)(31), medications policy and practice (32)(33)(34)(35)(36)(37)(38)(39)(40), patient safety and organizational safety culture (41,42), health reform (35,(43)(44)(45)(46)(47)(48)(49)(50), health insurance (50)(51)(52), emergency response (53)(54)(55)(56), and human resource management (3).…”