Evaluating the effect of hierarchical medical system on health seeking behavior: A difference-in-differences analysis in China

Zhou, Zhongliang; Zhao, Yaxin; Shen, Chi; Lai, Sha; Nawaz, Rashed; Gao, Jianmin

doi:10.1016/j.socscimed.2020.113372

Cited by 106 publications

(116 citation statements)

References 43 publications

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“…"Hierarchical medical system" refers to a system by which diseases are classified according to their severity and treatment difficulty. Medical institutions of different levels undertake different diseases and gradually ensure the medical process is carried out at all levels, from general medicine to specialized therapies [33]. Implementing the hierarchical medical system has enabled patients with chronic diseases to turn to primary medical and health service institutions or nearby pharmacies for related consultations, which has reduced the number of outpatient visits in tertiary hospitals.…”

Section: Discussionmentioning

confidence: 99%

Impact of China’s zero mark-up drug policy on drug cost of NCDs’ outpatients: an interrupted time series analysis

Xie

Qian

et al. 2021

BMC Health Serv Res

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Background China proposed the Zero Markup Drug Policy (ZMDP), which popularized in tertiary hospitals across the country in 2017, to control drug expenditures’ rapid growth further and reduce the public’s medical burden. This study aims to evaluate the impact of ZMDP on the drug cost of chronic disease outpatients in the tertiary hospital in Chongqing. Methods We collected and described the drug-cost data for outpatients with chronic diseases in a Chongqing’s tertiary hospital from 2015 to 2019. The instantaneous and long-term changes of the outpatient volume and average drug cost after the ZMDP were evaluated using interrupted time series (ITS). We also analyzed the policy’s impact under the stratification of gender, age, and basic medical insurance types. Results A total of 350,848 outpatients were collected from January 2015 to February 2019. After the ZMDP, the outpatient volume for diabetes, hypertension, and coronary heart disease (CHD) all showed a downward trend, with a decrease of 53.04 (P = 0.012), 142.19 (P < 0.01) and 12.16 (P < 0.001) per month. Simultaneously, the average drug cost decreased by 4.44 yuan (P = 0.029), 5.87 yuan (P < 0.001) and 10.23 yuan (P = 0.036) per month, respectively. By gender, the average drug cost of diabetes in males had the most considerable instantaneous change, reducing by 51.21 yuan (P = 0.017); the decline of CHD in women is the most obvious, with an average monthly decrease of 12.51 yuan (P < 0.001). By age, the instantaneous change of CHD was the greatest for those older than 65 years old, with a decrease of 102.61 yuan (P = 0.030). CHD in 46–65 years old showed the most significant reduction, with an average monthly decline of 11.70 yuan (P < 0.01). BMIUE’s hypertension had the most considerable instantaneous change, which decreased 59.63 yuan (P = 0.010). BMIUE’s CHD showed the most apparent downward trend, with an average monthly decrease of 10.02 yuan (P = 0.010). Conclusion The ITS analysis is an effective method of health policy evaluation. The implementation of the ZMDP can reduce the drug cost for chronic disease outpatients in the tertiary hospital and their economic burden. Follow-up policies still require targeted price adjustments in the health service system to adjust the drug cost-effectively.

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Section: Discussionmentioning

confidence: 99%

Impact of China’s zero mark-up drug policy on drug cost of NCDs’ outpatients: an interrupted time series analysis

Xie

Qian

et al. 2021

BMC Health Serv Res

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“…In 2015, the Chinese government began to develop a hierarchical medical system in public hospitals with the aim of achieving fair access to basic medical and health services [19]. One major measure is that a county hospital and several township health centers in the same area was merge into one institution, naming as "County Medical Community", aiming to improve the quality of medical services in rural areas.…”

Section: Discussionmentioning

confidence: 99%

Knowledge, Attitude and Prescription Practice on Antimicrobials Use among Physicians: A Cross-sectional Study in Zhejiang, China

Xu¹,

Tingyu²,

Shi³

et al. 2021

Preprint

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Introduction: Over-prescription of antimicrobials for patients is a major driver of bacterial resistance. The aim of the present study was to assess the knowledge, attitude and prescription in relation to antimicrobials among physicians in the Zhejiang province in China, and identify the determining factors. Methods: A total of 600 physicians in public county hospitals and township health institutions were surveyed cross-sectionally using a structured electronic questionnaire. Results: The questionnaire was completed by 580 physicians and accordingly, the response rate was 96.67%. The mean score of 11 terms related to antimicrobial knowledge was 6.81, and that an average of 32.1% of patients with upper respiratory tract infections (URIs) would be prescribed antimicrobials. Multivariate analysis indicated that young general practitioners with less training are more likely to contribute to high antimicrobial prescriptions (P<0.05). Older physicians with more trainings are more willing to provide patients with the correct knowledge regarding antimicrobials and less likely to prescribe antimicrobial s to URIs. The results of the correlation analysis showed that a positive connection was found between the doctor’s knowledge, attitude and prescription practice (P<0.05). Conclusion: Proper prescription of antimicrobials depends on adequate knowledge and regular training programs for physicians.

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“…In China, a new round of healthcare reform has been carried out since 2009. Some of the major tasks of this healthcare reform is to optimize healthcare utilization among different levels of hospitals through a hierarchical medical system and improve the medical quality of primary healthcare [1,22,23]. Specifically, reforms related to guiding the hospital choices of patients and optimizing hospital utilization are summarized in Section 2.2.…”

Section: Hospital Allocation and Health Reformsmentioning

confidence: 99%

Whether Public Hospital Reform Affects the Hospital Choices of Patients in Urban Areas: New Evidence from Smart Card Data

Wang

Jin

2021

IJERPH

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The effects of public hospital reforms on spatial and temporal patterns of health-seeking behavior have received little attention due to small sample sizes and low spatiotemporal resolution of survey data. Without such information, however, health planners might be unable to adjust interventions in a timely manner, and they devise less-effective interventions. Recently, massive electronic trip records have been widely used to infer people’s health-seeking trips. With health-seeking trips inferred from smart card data, this paper mainly answers two questions: (i) how do public hospital reforms affect the hospital choices of patients? (ii) What are the spatial differences of the effects of public hospital reforms? To achieve these goals, tertiary hospital preferences, hospital bypass, and the efficiency of the health-seeking behaviors of patients, before and after Beijing’s public hospital reform in 2017, were compared. The results demonstrate that the effects of this reform on the hospital choices of patients were spatially different. In subdistricts with (or near) hospitals, the reform exerted the opposite impact on tertiary hospital preference compared with core and periphery areas. However, the reform had no significant effect on the tertiary hospital preference and hospital bypass in subdistricts without (or far away from) hospitals. Regarding the efficiency of the health-seeking behaviors of patients, the reform positively affected patient travel time, time of stay at hospitals, and arrival time. This study presents a time-efficient method to evaluate the effects of the recent public hospital reform in Beijing on a fine scale.

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Evaluating the effect of hierarchical medical system on health seeking behavior: A difference-in-differences analysis in China

Cited by 106 publications

References 43 publications

Impact of China’s zero mark-up drug policy on drug cost of NCDs’ outpatients: an interrupted time series analysis

Impact of China’s zero mark-up drug policy on drug cost of NCDs’ outpatients: an interrupted time series analysis

Knowledge, Attitude and Prescription Practice on Antimicrobials Use among Physicians: A Cross-sectional Study in Zhejiang, China

Whether Public Hospital Reform Affects the Hospital Choices of Patients in Urban Areas: New Evidence from Smart Card Data

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