Impacts of the zero mark-up drug policy on hospitalization expenses of COPD inpatients in Sichuan province, western China: an interrupted time series analysis

Abstract

Background: Since 1950, the hospitals had been permitted to take a 15% mark-up of drug purchase price to remedy the loss of public hospitals and doctors' salaries in China due to tight government budget. This policy resulted in an increasing over-prescriptions which increased burden for patients eventually. The soaring medical expenditures prompted Chinese government to launch the zero mark-up drug policy (ZMDP) in 2009, which aims to eliminate physicians' financial incentives and lighten patients' economic burden through cancelling the 15% mark-up. The purpose of this study is to assess the impacts of the ZMDP on hospitalization expenses for inpatients with chronic obstructive pulmonary disease (COPD) in western China.

Method: An interrupted time series was used to assess the impact of the ZMDP in 25 tertiary hospitals of Sichuan province, in which the policy was implemented in 2017. Monthly average total hospitalization expenses including drug expenses, medical service expenses and diagnosis expenses of COPD inpatients were analyzed with segmented regression model developed from January 2015 to June 2018.

Results: After the intervention of the ZMDP, the total hospitalization expenses of COPD patients significantly decreased immediately by 1022.06 CNY (P = .011). The post-policy long-term trend was decreasing by 125.32 CNY (P < .001) per month compared to the pre-policy period. The drug expenses kept downward trend both before and after the policy implementation. It had decreased by 46.42 CNY (P < .001) per month on average before the policy implementation and then dropped 1073.58 CNY (P < .001) immediately after the policy was implemented. Meanwhile, the medical service expenses had an increasing baseline trend of 14.93 CNY (P < .001) per month before the policy intervention, but it increased 197.75 CNY immediately after the policy was implemented (P = .011). The pre-policy period long-term trend of diagnosis expenses had increased by 25.78 CNY (P < .001) per month and decreased immediately by 310.78 CNY (P = .010). The post-policy trend was decreasing by 35.60 CNY (P = .001) per month compared to the pre-policy period.

Conclusion: Our study suggested that the ZMDP have been an effective intervention to curb the increase of hospitalization expenses for inpatients with COPD, especially the drug expenses in western region of China.

Keywords: Chronic obstructive pulmonary disease; Drug expenses; Hospitalization expenses; Interrupted time series; Zero mark-up drug policy.

Fig. 1

Trend in the monthly average total hospitalization expense (CNY) for 25 tertiary hospitals in Sichuan, January 2015–June 2018. The vertical line shows the time when the ZMDP was launched

Fig. 2

Trend in the monthly average medical service expense (CNY) for 25 tertiary hospitals in Sichuan, January 2015–June 2018. The vertical line shows the time when the ZMDP was launched

Fig. 3

Trend in the monthly average diagnosis expense (CNY) for 25 tertiary hospitals in Sichuan, January 2015–June 2018. The vertical line shows the time when the ZMDP was launched

Fig. 4

Trend in the monthly average drug expense (CNY) for 25 tertiary hospitals in Sichuan, January 2015–June 2018. The vertical line shows the time when the ZMDP was launched