Will the zero-margin drug policy reduce the economic burden of stroke patients in China?

Abstract

Background China is facing a more severe stroke challenge. In 2017, China fully implemented the zero-margin drug policy (ZMDP), cancelling 15% of drug markups in public hospitals. Based on the “System of Health Accounts 2011” (SHA 2011), this paper explores the changes in the economic burden of stroke in China after implementing ZMDP to provide an accurate reference for policymakers. Methods Stroke patients from 2016 to 2018 were selected by multistage stratification probability-proportional random sampling in Shanxi Province. A total of 223 187 samples were included. Regression discontinuity design (RDD) was used to measure the change of drug proportion and cost. Sensitivity analysis and subgroup analysis were implied to determine the stability of the results. Results The current curative expenditure on stroke from 2016 to 2018 was 4374.69, 3727.22, and 3752.52 million Chinese Yuan (CNY). About 90% of the cost occurred during hospitalization, and 60% in general hospitals. After the implementation of ZMDP, the drug proportion from 46.54% (interquartile range (IQR) = 37.10%, 55.14%) in 2016 to 36.40% (IQR = 25.82%, 48.58%) in 2018, and average hospitalization cost per stay was from 7950.02 (IQR = 4938.76, 12 639.90) CNY in 2016 to 7362.08 (IQR = 4892.82, 11 501.40) CNY in 2018. RDD showed the drug proportion decreased by 2.76% (95% confidence interval (CI) = 1.17%, 4.35%, P = 0.001), and the expense decreased by 4698.34 (95% CI = 3047.59, 6349.09, P < 0.001) CNY. Conclusions The economic burden of stroke patients in China was severe. ZMDP played a noticeable effect in reducing drug proportion and hospitalization costs. The Chinese government should continue to implement relevant policies to control stroke costs according to regional and population characteristics.

A bibliometric analysis of telerehabilitation services for patients with stroke

“…As a result, more resources were available for research publications generated in developed countries than in developing countries. China is the world's largest developing country ( 51 ), and stroke is the leading cause of disability-adjusted life years nationally ( 52 ). The commitment to developing remote stroke services in China was witnessed through the establishment of the National Telestroke Center in 2014 to provide a nationwide network platform for stroke services.…”

Medical expenditure and its influencing factors of patients with hypertension in Shanxi Province, China: a study based on ‘System of Health Accounts 2011’ and multiple-layer perceptron neural network

“…Long-term medication, irrational use of medicines by medical staff, blind and excessive consumption of new specialty drugs and imported drugs emerge one after another. 35 36 In addition, in outpatient treatment, the impact of examination fee and test fee on CCE ht-out follows drug fee, which implies that the phenomenon of ‘relying on medicine, examination and test to support doctors’ still exists. Therefore, the government should further strengthen the standardisation and supervision of drugs and inspection items, improve the usage of generic medication and inspection efficiency.…”

Increasing Importance of Patients-generated Real World Data for Healthcare Policy Decisions about Medicinal Products - Volume II

“…The Statistical Yearbook of Health and Family Planning of Liaoning Province (2015)(2016)(2017)(2018)(2019)(2020), the Liaoning Provincial Health Financial Annual Report (2015)(2016)(2017)(2018)(2019)(2020), the Liaoning Provincial Government Health Investment Monitoring Data (2015)(2016)(2017)(2018)(2019)(2020), and the Liaoning Provincial Statistical Yearbook, are the statistical data from the health and related administrative departments that represent the total cost of treatment services in Liaoning Province (2015)(2016)(2017)(2018)(2019)(2020). Sample data from the multistage stratified probabilities-proportional random sampling approach was used to collect patient healthcare costs, population data and clinical information about healthcare facilities (Ma et al, 2020;Fang et al, 2021). Dalian, Fushun, Jinzhou, Panjin and Tieling cities were selected to conduct random, multistage spot checks in the first analytic phase, including the following variables GDP, national income, national income per capita and population density.…”