Impact of Beijing healthcare reform on the curative care expenditure of outpatients with noncommunicable diseases based on SHA2011 and interrupted time series analysis

Impacts of the Zero-Markup Drug Policy on Hospitalization Expenses of Patients with Stroke in Western China: An Interrupted Time Series Analysis

Background

In 2016, an innovative medical pricing reform called zero-markup drug policy (ZMDP) was implemented in selected pilot cities in China, which focuses on curbing the unreasonable growth of medical expenses. This study aimed to evaluate the impacts of ZMDP on medical expenditure of stroke in western China.

Methods

The quantitative data of inpatients diagnosed with stroke was extracted from the medical insurance system in 7 tertiary public hospitals. An interrupted time series (ITS) was used to analyze the instantaneous level and long-term trend changes of hospitalization expenses per visit from January 2015 to November 2018.

Results

A total of 22,407 stroke inpatients were extracted. The total hospitalization expense per visit had the highest proportion of 20,000 CNY and above (33.66%). After the ZMDP, the median total hospitalization expense and western medicine expense per visit decreased by 631.74 CNY and 966.35 CNY, respectively (P <0.001). Before the policy, the total hospitalization expense, traditional Chinese medicine (TCM) expense, examination expense, treatment expense, laboratory expense and surgical expense per visit showed upward trends (P<0.05), while the anesthesia expense per visit showed a downward trend (P<0.001). When the policy was implemented, the anesthesia expense per visit instantaneously increased by 91.70% (P<0.001). After the policy, the total hospitalization expense, western medicine expense, TCM expense, treatment expense and surgical expense per visit changed from upward trends to downward trends (P<0.05). The anesthesia expense per visit changed from a downward trend to an upward trend (P<0.001), and the examination expense per visit maintained an upward trend (P=0.005).

Conclusion

The economic burden of stroke inpatients decreased significantly with the implementation of the ZMDP, especially for the drug expenses. The medical service expenses increased significantly, reflecting the improvement in the value of medical staff's technical labor. However, the unexpected increase in the examination expenses was likely to be associated with the unreasonable medical compensation mechanism.

Who consumes curative care expenditure of medical institutions in Beijing: a case study based on System of Health Accounts 2011

BACKGROUND

China's health system is challenged by complex health problems experienced by different population groups and caused by multiple diseases. This study examined the distribution of curative care expenditure (CCE) of medical institutions in Beijing using beneficiary characteristics such as residency, gender, age, and disease. Suggestions are presented for the development of health policies.

METHODS

A total of 81 medical institutions with approximately 80 million patients in Beijing, China, were selected via a multistage stratified cluster random sampling approach. Based on this sample, the System of Health Accounts 2011 was used to estimate the CCE of medical institutions.

RESULTS

The CCE of medical institutions in Beijing was ¥246.93 billion in 2019. The consumption of patients from other provinces was ¥60.04 billion, accounting for 24.13% of the total CCE. The CCE of female consumption (52.01%/¥128.42 billion) exceeded that of male consumption (47.99%/¥118.51 billion). Almost half of the CCE (45.62%/¥112.64 billion) was consumed by patients aged 60 or above. Adolescent patients up to an age of 14 (including those aged 14) mainly chose secondary or tertiary hospitals for treatment. Chronic non-communicable diseases accounted for the largest share of CCE consumption, with circulatory diseases accounting for the highest proportion.

CONCLUSIONS

This study identified significant differences in CCE consumption in Beijing according to region, gender, age, and disease. Currently, the utilization of resources in medical institutions is not reasonable, and the hierarchical medical system is not sufficiently effective. Therefore, the government needs to optimize the allocation of resources according to the needs of different groups and rationalize the institutional process and functions.

The impact of comprehensive public hospital reforms on the direct medical cost of inpatients with coronary heart disease

Objectives

To curb the unreasonable growth of medical expenses and reduce the burden of medical treatment, Beijing launched two rounds of comprehensive reform of public hospitals. In the two reforms, the addition of drugs and consumables was canceled successively. This study compared the changes in the direct medical cost of inpatients with coronary heart disease (CHD) in the three stages of two comprehensive public hospital reforms in Beijing and provides data support for health reform policies.

Setting

CHD diagnosis and treatment data were extracted from the Hospital Information System (HIS) of 33 public hospitals. The total amount and composition of the direct medical expenses of CHD inpatients in the three stages were calculated. Interrupted time series analysis was used to study the instantaneous changes and trend changes in the three stages.

Participants

The data were obtained from the HIS system of 33 public hospitals above the second level in Beijing. A total of 66,647 medical and diagnosis records and 24,371,139 charge detail records were included.

Results

After the two reforms, the total cost for CHD inpatients with most clinical classifications and treatment methods decreased. The proportion of drug and consumable costs decreased significantly, whereas the proportion of medical consultation service costs increased. Drug-treated patients were mainly affected by the instantaneous reforms, percutaneous coronary intervention-treated patients were simultaneously affected by instantaneous and trending effects, and coronary artery bypass graft-treated patients were mainly affected by the reform trend.

Conclusion

The overall change in the direct medical cost of CHD inpatients was consistent with the goal of the comprehensive medical reform of public hospitals in Beijing, which is "total control and structural adjustment."

Danhong Injection Price Trend and Its Utilization by Coronary Heart Disease Patients: Evidence From Hospital Records in China

Background: Danhong injection (DHI) accounts for the highest proportion of drug costs for inpatients with coronary heart disease (CHD). However, if DHI price influences utilization remains unclear.

Objective: The objective was to compare changes in the use of DHI for CHD patients during three stages after two comprehensive reforms of public hospitals in Beijing. These findings will provide support for controlling the drug burden of CHD patients and regulating drug use behavior.

Research Design: CHD diagnosis and treatment data were extracted from the Hospital Information System (HIS) of 33 public hospitals. Patients were grouped according to different treatment methods and clinical classifications. Changes in the utilization of DHI, including the use rate (the percentage of CHD patients using DHI), number of prescribed units (average number of units of DHI prescribed per hospital stay), and cost of DHI per hospital stay (equal to the unit price multiplied by the number of prescribed units) between the three stages were statistically analyzed. Association rules were applied to identify changes in drug combinations.

Results: After the two reforms, the unit price of DHI dropped from $6.46 to $5.61. At the same time, the use rate increased from 20.77 to 24.00%, the number of prescribed units dropped from 29.76 to 29.21, and the cost of DHI per hospital stay dropped from $192.12 to $163.96. The changes in the use rate and number of prescribed units varied among patients with different clinical types and treatment methods, and the cost of CHI per hospital stay was consistent with the overall situation. The variety of drugs used in combination with DHI remained relatively stable.

Conclusion: The use rate of DHI for CHD patients increased, indicating increased applications of DHI in clinical practice. Due to the drop in price, the cost of using DHI decreased, and the financial burden of this drug was reduced.