Healthcare Supply Chain Network Coordination Through Medical Insurance Strategies with Reference Price Effect

Price Decision-Making in Dual-Channel Healthcare Services Supply Chain Considering the Channel Acceptance, Price Ceiling, and Public Welfare

Given that an increasing number of online healthcare channels play an essential role as a supply method in the healthcare service supply chain (HSSC), this paper studies the price decision-making problem for a dual-channel HSSC considering the channel acceptance, price ceiling, and public welfare. In this HSSC, a healthcare institution establishes both a traditional offline channel and an online channel to provide healthcare services for some health conditions. Considering the public welfare of healthcare institutions, we employ a sum formula of economic revenue and patient surplus to describe the total revenue of both healthcare service channels. Based on the Stackelberg game, we develop a decentralized supply chain model to maximize supply chain members' revenue. By employing the Karush-Kuhn-Tucker optimality condition, we derive an analytical expression for the optimal service price, which includes the functions of the public welfare coefficient and channel acceptance. Finally, we conduct extensive numerical analyses under various system parameters to verify the optimal price decision-making strategies. Our analytical results indicate that: (1) the healthcare service price is closely related to the patients' channel acceptance, the public welfare coefficient, and the government price ceiling policy; (2) the public welfare coefficient strongly influences the service price and total revenue, and its increase can decrease the economic revenue of the HSSC; (3) the acceptance of online channels is an essential factor that should be carefully considered in the construction of a dual-channel HSSC. Improving patient acceptance of online channels is conducive to developing and improving a sustainable dual-channel HSSC.

How to Make Primary Healthcare More Popular: Evidence from the Middle-Aged and Elderly in China

Since 2001, China has been an aging society; it is expected to become superaged by 2033. This rapid aging trend poses a challenge to the elderly regarding their pension services and healthcare. Primary healthcare has great potential for serving older adults in the community, yet it is not popular. This study used 1977 samples from the 2018 China Health and Retirement Longitudinal Study database to explore the use of outpatient services in primary care institutions among the middle-aged and elderly. Using a structural equations model, we constructed a framework to explore pathways leading to primary outpatient use. We discovered that the supply of primary health services had a significant direct and mediating effect on the utilization of primary outpatient services, and that community pension services may indirectly discourage it. In addition, the supply of primary health services has a suppressor effect between medical insurance and primary outpatient utilization. Health insurance directly promotes primary outpatient utilization, while the supply of primary care institutions suppresses the positive influence of medical insurance on the utilization of primary outpatient services. Therefore, community pension services should pay attention to differentiated services. Moreover, adjusting the coordinated development of medical insurance and the supply of primary healthcare could enhance the positive effects of medical insurance for outpatients.

Impact of the National Health Insurance Coverage Policy on the Utilisation and Accessibility of Innovative Anti-cancer Medicines in China: An Interrupted Time-Series Study

Objective: The study aimed to evaluate the impact of the National Health Insurance Coverage (NHIC) policy on the utilisation and accessibility of innovative anti-cancer medicines in Nanjing, China. Methods: We used the adjusted World Health Organisation and Health Action International methodology to calculate the price and availability of 15 innovative anti-cancer medicines included in the National Health Insurance drug list in 20 tertiary hospitals and six secondary hospitals in Nanjing before and after NHIC policy implementation. Interrupted time-series regression was used to analyse the changes in the utilisation of the study medicines. Results: The price reduction rates of innovative anti-cancer medicines ranged between 34 and 65%. The mean availability rate was 27.44% before policy implementation and increased to 47.33% after policy implementation. The utilisation of anti-cancer medicines suddenly increased with a slope of 33.19-2,628.39 when the policy was implemented. Moreover, the usage rate of bevacizumab, bortezomib, and apatinib significantly increased (p < 0.001, p = 0.009, and p < 0.001, respectively) after policy implementation. With regard to price reduction and medical insurance reimbursement, the medicines became more affordable after policy implementation (0.06-1.90 times the per capita annual disposable income for urban patients and 0.13-4.46 times the per capita annual disposable income for rural patients). Conclusion: The NHIC policy, which was released by the central government, effectively improved the utilisation and affordability of innovative anti-cancer medicines. However, the availability of innovative anti-cancer medicines in hospitals remained low and the utilisation of innovative anti-cancer medicines was affected by some factors, including the incidence of cancer, limitation of indications within the insurance program, and the rational use of innovative anti-cancer medicines. It is necessary to improve relevant supporting policies to promote the affordability of patients. The government should speed up the process of price negotiation to include more innovative anti-cancer medicines in the medical insurance coverage, consider including both medical examinations and adjuvant chemotherapy in the medical insurance, and increase investment in health care.