Impact of the zero‐markup drug policy on hospitalisation expenditure in western rural China: an interrupted time series analysis

Abstract

A statistically significant absolute decrease in the level or trend of monthly average hospitalisation expenditure and monthly average hospitalisation expenditure after reimbursement was detected after the introduction of the zero-markup drug policy in western China. However, hospitalisation expenditure and hospitalisation expenditure after reimbursement were still increasing. More effective policies are needed to prevent these costs from continuing to rise.

Effects of different mark-up drug policies on drug-related expenditures in tertiary public hospitals: an interrupted time series study in Shanghai, China, 2015-2018

“…There are two typical mark-up drug policies, one is Fixed Percent Mark-up Drug (FPM) policy, which allows drugs to be sold on fixed mark-up percent based on the purchase price; the other is Zero Mark-up Drug (ZMD) policy, which requires all public hospitals to prescribe drugs at purchase price without including a mark-up (23). Previous studies mostly presented positive effects on healthcare expenditures shortly after implementing ZMD policy, but showed mixed results regarding long-term effects (11,14,24). Regarding FPM policy, hospitals were found to show more preference for expensive drugs, which led to increasing healthcare expenditures and high drug revenue proportion in both outpatient and inpatient healthcare revenue (9,25).…”

A Systematic Review of Zero-markup Policy for Essential Drugs Effect on Medical Treatment

“…We excluded 25 records that did not meet our inclusion criteria. Nine studies (included time series study, retrospective cohort study, and quasi-experimental study) were included in this systematic review [1][2][3][4][6][7][8][9][10]. The characteristics of the included studies are summarized in Table 3.…”

“…A retrospective longitudinal study indicated that in absolute terms, there were increased annual patient-visits [6]. Yang et al (2017) indicated the statistically significant decreasing of monthly hospitalization expenditure [2]. Fu et al (2018) showed that a rise in expenditures for medical services and no changes in total health expenditures [8].…”

“…In 1954, Policy on Drug Markups (PoDM) announced by Chinese government granted medical institutions to raise pharmaceuticals price by maximum to 15% cap [1]. Since 1980s lacking enough fiscal subsidy and facing raised drug price, patients were struggling with health care [2]. To alleviate these challenges, Medical health reform was initiated by Chinese government and Zero-markup Policy for Essential Drugs (ZPED) was published in 2009.…”

“…However, Yang et. al, found that medical expenditure was still increasing, although its rising trend was restrained [2]. This might be that medical institutions were entitled to raise other medical expenditure, such as diagnosis payment, nursing fees, surgery expense and treatment fees, under ZPED [2].…”