Impact of China’s healthcare price reforms on traditional Chinese medicine public hospitals in Beijing: an interrupted time-series study

Abstract

ObjectiveTo evaluate the 2017 implementation of China’s 2009 healthcare price reforms on Beijing’s secondary and tertiary traditional Chinese medicine (TCM) hospitals.DesignWe employed a panel-interrupted time-series model with hospital fixed effects to estimate the impact of the price reforms.SettingBeijing, April 2014 to April 2018.ParticipantsAll TCM hospitals in Beijing.Outcome measuresOur dependent variables comprised the monthly outpatient and inpatient revenues, the number of monthly outpatient visits and inpatient admissions, the average total expenditures per outpatient visit and per inpatient admission, the average drug expenditures (except herbal medicines) per outpatient visit and per inpatient admission and the average medical service expenditures per outpatient visit and per inpatient admission.ResultsIn tertiary hospitals, the price reforms led to significant reductions in the number of outpatient visits (23.1%), inpatients admission (4.6%) and drug expenditures (except herbal medicines) per inpatient admission (14.0%), and an instant raise in average total expenditure per outpatient (22.0%), medical service expenditures per outpatient visit (58.2%) and inpatient admission (19.0%). There was no significant association between the price reforms and the monthly outpatient and inpatient revenues. After the price reforms, the previous upward trend in medical service expenditures per outpatient visit rose more sharply (from 0.5% to 1.6%). In secondary hospitals, the price reforms decreased the level of drug expenditures (except herbal medicines) per outpatient visit (13.0%) and per inpatient admission (20.8%), but increased medical service expenditures per inpatient admission by 19.0%.ConclusionThe Beijing price reforms adjusted the cost structures in secondary and tertiary TCM hospitals without negatively impacting the operation of the hospitals, and through the increased hierarchical medical service fee, shifted patient choices away from tertiary to other health facilities, especially for patients with minor illnesses.

Different Impacts of the zero-markup drug policy on county general and traditional Chinese medicine hospitals: Evidence from Shandong province, China

“…According to the goal of the ZMDP, the outcome variables in this study were revenue from medicine sales, the share of revenue from medicine sales (divide the amount of revenue from medicine by total revenue except government subsidies), revenue from medical care services, government subsidies, which reflected the structure of the revenue of county hospitals [7,11,14]. The outcome variables also included revenue and expenditure surplus, gross revenue, the number of annual outpatient and inpatient visits, which reflected the impacts of the policy on the overall operation of county hospitals.…”

“…The ZMDP was first implemented at primary care institutions in 2010, then expanded to county public hospitals in 2012, and then expanded to all county public hospitals in 2015 in Shandong Province, one of the most populated provinces in China. The ZMDP was not applied to herbal medicines to support the utilization of the TCM [7,11], which implied that the policy may exert different impacts between county general and TCM hospitals.…”

“…With the ZMDP, county TCM hospitals could try to increase the volumes and intensity of TCM services with higher price-cost margins to compensate for revenue losses. The revenue from Chinese medicines as a share of total drug revenue in county TCM hospitals and county general hospitals were 36% and 6%, respectively [11], which implied that county TCM hospitals had higher capacities than county general hospitals to shift the revenue generation from western medicines to Chinese medicines [13].The different structure of revenue generation between county general hospitals and TCM hospitals provides an opportunity for analyzing the effects of the ZMDP. Some studies have examined the effects of the ZMDP.…”

An Exploration of the Active Ingredients of <i>Salvia miltiorrhiza</i> in the Treatment of Gastric Cancer and Its Mechanism Based on Network Pharmacology

“…In recent years, Traditional Chinese Medicine (TCM) has played an increasingly important role in the prevention and treatment of diseases for Chinese people, Asians in general, and even people in other countries [6]. This is because it has good therapeutic effects and a low rate of side effects.…”

Different Impacts of the zero-markup drug policy on county general and traditional Chinese medicine hospitals: Evidence from Shandong province, China

“…With the ZMDP, county TCM hospitals could try to increase the volumes and intensity of TCM services with higher price-cost margins to compensate for revenue losses. The revenue from Chinese medicines as a share of total drug revenue in county TCM hospitals and county general hospitals were 36% and 6%, respectively [13], which implied that county TCM hospitals had higher capacities than county general hospitals to shift the revenue generation from western medicines to Chinese medicines [15].The different structure of revenue generation between county general hospitals and TCM hospitals provides an opportunity for analyzing the effects of the ZMDP. Some studies have examined the effects of the ZMDP.…”