Short-term differences in drug prices after implementation of the national essential medicines system: A case study in rural Jiangxi Province, China

Junyong, Wang; Liu, Xia; Wang, Shuzhen; He-li, Chen; Wang, Xun; Zhou, Wei; Wang, Li; Zhu, Yanchen; Xiang, Zheng; Hao, Mo

doi:10.4103/0253-7613.165192

Cited by 13 publications

(8 citation statements)

References 7 publications

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“…The instantaneous changes in diabetes and CHD are statistically significant, and the analysis decreased by 45.51 yuan and 77.46 yuan, while there is no significant difference in CHD. This illustrates that, on the whole, the ZMDP effectively regulates the drug cost for different diseases, has universal applicability, consistent with the study's findings by Wang [30]. Chao's [31] research also shows that reasonable prices for essential drugs and the implementation of the ZMDP can reduce the average cost of prescriptions.…”

Section: Discussionsupporting

confidence: 84%

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: Discussionsupporting

confidence: 84%

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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“…This result revealed that the CPMP failed to either reduce the drug expense or combat its growth. This discovery was also in line with currently available studies [ 22 , 23 , 26 ], where the CPMP was reported to be insufficient not only to lower drug wholesale prices but also to bring down drug expenses. The failure of CPMP may be justified by the fact that health institutions had limited incentives to lower their purchase prices (wholesale prices) to save money because of the ZMDP [ 26 ].…”

Section: Discussionsupporting

confidence: 84%

“…This discovery was also in line with currently available studies [ 22 , 23 , 26 ], where the CPMP was reported to be insufficient not only to lower drug wholesale prices but also to bring down drug expenses. The failure of CPMP may be justified by the fact that health institutions had limited incentives to lower their purchase prices (wholesale prices) to save money because of the ZMDP [ 26 ]. Moreover, centralized drug procurement system has been in place for more than a decade and the CPMP launched in Sanming city was nothing more than a new version of it and therefore, it is reasonable to believe that pharmaceutical companies has already adapted to the CPMP well.…”

Section: Discussionsupporting

confidence: 84%

Does the leading pharmaceutical reform in China really solve the issue of overly expensive healthcare services? Evidence from an empirical study

Dou

Huang

et al. 2018

PLoS ONE

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BackgroundHealthcare system reform of Sanming city has become a leading healthcare reform model in China. It has developed a rigorous pharmaceutical reform consisted of the Zero Mark-up Drug Policy and the Centralized Procurement of Medicine Policy to bring down drug expenses and total health expenditures. However, despite the credit and much attention have been given to Sanming’s pharmaceutical reform, its impact still remains unclear. Therefore, the purpose of this study was to explore the impact of the pharmaceutical reform of Sanming on both drug and total health expenditures.MethodsInterrupted time series analysis with three segments divided by two intervention points was employed to evaluate the impact of the pharmaceutical reform. Segment 1 was the pre-reform period which captured the baseline information. Segment 2 occurred after the first intervention point when the Zero Mark-up Drug Policy was implemented, whereas Segment 3 was after the implementation of the Centralized Procurement of Medicine Policy. Primary outcomes are outpatient drug expenditure, outpatient total health expenditure, inpatient drug expenditure, and inpatient total health expenditure. Data spanning from May 2012 to May 2014 are included.ResultsBoth drug and total health expenditures exhibited rising trends before any policy was carried out. The launch of Zero Mark-up Drug Policy led to significant instant reductions in levels of outpatient drug expenditure (coefficient = -6,602.99, p<0.01), outpatient total health expenditure (coefficient = -9,958.58, p<0.05), inpatient drug expenditure (coefficient = -7,520.90, p<0.01), and inpatient total health expenditure (coefficient = -16,737, p<0.01). Moreover, the previous upward trends were changed into downward trends for inpatient drug expenditure (coefficient = -2,747.02, p = 0.00) and total health expenditure (coefficient = -3,069.29, p = 0.12). However, after the implementation of Centralized Procurement of Medicine Policy, we observed no significant instant level changes and also, the inpatient drug expenditure (coefficient = 372.95, p = 0.01) and total health expenditure (coefficient = 788.76, p = 0.06) resumed upward trends again.ConclusionsAlthough the pharmaceutical reform could control or reduced drug expenditure and total health expenditure in short term, expenditures gradually resumed growing again and reached or even exceeded their baseline levels of pre-reform period, indicating the effect became weakened or even faded out in long term. In all, the pharmaceutical reform as a whole failed to meet its goal of combating sharp growth of drug and total health expenditure.

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“…[ 2 – 6 ] Not surprisingly, the data from Jiangxi and Shaanxi provinces and nation-level data of all provinces also show that the NEMS, particularly the ZMDP for essential medicines, led to significant reduction in per-visit medicine charges in rural areas. [ 3 , 4 , 7 ] Additional effects are physician prescription-pattern changes and differences in medicine prices between urban and rural healthcare institutions. [ 1 , 2 , 8 ] However, the increase or decrease of the medicine or healthcare charges was largely dependently on the hospital levels as Wang et al showed.…”

Section: Introductionmentioning

confidence: 99%

Descriptive Analysis on the Impacts of Universal Zero-Markup Drug Policy on a Chinese Urban Tertiary Hospital

et al. 2016

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BackgroundUniversal Zero-Markup Drug Policy (UZMDP) mandates no price mark-ups on any drug dispensed by a healthcare institution, and covers the medicines not included in the China’s National Essential Medicine System. Five tertiary hospitals in Beijing, China implemented UZMDP in 2012. Its impacts on these hospitals are unknown. We described the effects of UZMDP on a participating hospital, Jishuitan Hospital, Beijing, China (JST).MethodsThis retrospective longitudinal study examined the hospital-level data of JST and city-level data of tertiary hospitals of Beijing, China (BJT) 2009–2015. Rank-sum tests and join-point regression analyses were used to assess absolute changes and differences in trends, respectively.ResultsIn absolute terms, after the UZDMP implementation, there were increased annual patient-visits and decreased ratios of medicine-to-healthcare-charges (RMOH) in JST outpatient and inpatient services; however, in outpatient service, physician work-days decreased and physician-workload and inflation-adjusted per-visit healthcare charges increased, while the inpatient physician work-days increased and inpatient mortality-rate reduced. Interestingly, the decreasing trend in inpatient mortality-rate was neutralized after UZDMP implementation. Compared with BJT and under influence of UZDMP, JST outpatient and inpatient services both had increasing trends in annual patient-visits (annual percentage changes[APC] = 8.1% and 6.5%, respectively) and decreasing trends in RMOH (APC = -4.3% and -5.4%, respectively), while JST outpatient services had increasing trend in inflation-adjusted per-visit healthcare charges (APC = 3.4%) and JST inpatient service had decreasing trend in inflation-adjusted per-visit medicine-charges (APC = -5.2%).ConclusionImplementation of UZMDP seems to increase annual patient-visits, reduce RMOH and have different impacts on outpatient and inpatient services in a Chinese urban tertiary hospital.

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Short-term differences in drug prices after implementation of the national essential medicines system: A case study in rural Jiangxi Province, China

Cited by 13 publications

References 7 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

Does the leading pharmaceutical reform in China really solve the issue of overly expensive healthcare services? Evidence from an empirical study

Descriptive Analysis on the Impacts of Universal Zero-Markup Drug Policy on a Chinese Urban Tertiary Hospital

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