Dataset Information

How Did Zero-Markup Medicines Policy Change Prescriptions in the Eyes of Patients?-A Retrospective Quasi-Experimental Analysis.

ABSTRACT:

Background

China implemented the zero-markup medicines policy to reverse the overuse of medicine in public health institutions, by changing the distorted financing mechanism, which heavily relies on revenue generated from medicines. The zero-markup medicines policy was progressively implemented in city public hospitals from 2015 to 2017.

Objective

This study is expected to generate convincing evidence with subjective measurements and contribute to a more comprehensive evaluation of the policy from both objective and subjective perspectives.

Methods

This study was based on a large patient-level dataset with a quasi-experimental design. We employed the difference-in-difference (DID) method, combined with propensity score matching methods, to estimate the causal effect of the policy in reducing overprescriptions from the patient perspective.

Results

The study estimated a statistically significant increased probability that the responded outpatients denied overprescription in their visiting hospitals. The mean interacted policy effect, in percentage points, of all observations were positive (logit DID model: 0.15, z = 10.27, SE = 0.01; PSM logit DID model: 0.15, z = 10.26, SE = 0.01; PSM logit DID hospital fixed-effect model: 0.12, z = 3.00, SE = 0.04).

Discussion

The policy might reduce overprescription in public hospitals from the patient's perspective. The patient's attitude is one aspect of a comprehensive policy evaluation. The final concrete conclusion of the policy evaluation can only be made through a systematic review of the studies with rigorous design and with both objective and subjective measurements.

SUBMITTER: Cheng H

PROVIDER: S-EPMC9566082 | biostudies-literature | 2022 Sep

REPOSITORIES: biostudies-literature

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Publications

How Did Zero-Markup Medicines Policy Change Prescriptions in the Eyes of Patients?-A Retrospective Quasi-Experimental Analysis.

Cheng Hanchao H Zhang Yuou Y Sun Jing J Liu Yuanli Y

International journal of environmental research and public health 20220927 19

<h4>Background</h4>China implemented the zero-markup medicines policy to reverse the overuse of medicine in public health institutions, by changing the distorted financing mechanism, which heavily relies on revenue generated from medicines. The zero-markup medicines policy was progressively implemented in city public hospitals from 2015 to 2017.<h4>Objective</h4>This study is expected to generate convincing evidence with subjective measurements and contribute to a more comprehensive evaluation o ...[more]

PMID: 36231527

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Project description:BackgroundAfter the successful reforms of drug pricing, China has implemented two significant reforms to reduce medical consumables expenses: the elimination of markup on prices (zero-markup policy) and the implementation of centralized procurement of high-value medical consumables (national procurement policy). The public hospitals in Guangdong province had implemented the zero-markup policy and national procurement policy for coronary stents. Currently, research on the zero-markup consumable policy and national procurement of coronary stents for medical consumables at the hospital level lacks analysis of changes in cost structures (other expenses) and studies on hospital response strategies.ObjectiveThis study aims to examine the effects of these reforms on hospitalization expenses for patients undergoing coronary stent implantation, including the specific changes in total hospitalization expenses, the component of total expenses, and the proportion of each expense category following the implementation of the reforms.MethodsData were obtained from the case management system of Guangdong Provincial Second People's Hospital in China. An interrupted time series design was employed to assess the impact of the reforms on inpatient expenses.ResultsBefore the reforms, the median total hospitalization expense was 63,124.98 CNY, which decreased to 58,332.50 CNY during the zero-markup consumable policy period and further decreased to 48,266.34 CNY during the national centralized procurement policy period. The median expenses for western drugs, diagnostic tests, treatment, surgery, medical consumables, and other categories also displayed varying patterns. The expenses for medical consumables notably decreased from 39,119.52 CNY to 785.79 CNY after the implementation of the national procurement policy. The slope change of medical consumables expenses decreased by 600.81 CNY per month after the zero-markup policy, and the immediate effect of the national procurement policy resulted in a decrease of 32,160.81 CNY in median medical consumables expenses. Other expense categories experienced notable changes, with a substantial increase in the median of other expenses by 28,350.39 CNY during the national procurement policy period.ConclusionThe reforms in medical consumables pricing and procurement have effectively reduced the cost of consumables for inpatients undergoing coronary stent plantation. The analysis of interrupted time series revealed that the elimination of the consumable markup policy had a limited effect on the level and trend of total hospitalization expenses. However, the implementation of the national procurement policy for coronary stents led to a significant reduction in medical consumables expenses. The study found that after the reform, hospitals mitigated revenue losses by increasing ambiguous other expenses, which may involve the shifting of medical consumable expenses in their accounting records.

Project description:BackgroundIn April 2009, the Chinese government launched Zero Markup Drug Policy (ZMDP) to adjust medical institutions' revenue and expenditure structures.ObjectiveThis study evaluated the impact of implementing ZMDP (as an intervention) on the drug costs for managing Parkinson's disease (PD) and its complications from the healthcare providers' perspective.MethodsThe drug costs for managing PD and its complications per outpatient visit or inpatient stay were estimated using electronic health data from a tertiary hospital in China from January 2016 to August 2018. An interrupted time series analysis was conducted to evaluate the immediate change following the intervention (step change, β1) and the change in slope, comparing post-intervention with the pre-intervention period (trend change, β2). Subgroup analyses were conducted in outpatients within the strata of age, patients with or without health insurance, and whether drugs were listed in the national Essential Medicine List (EML).ResultsOverall, 18,158 outpatient visits and 366 inpatient stays were included. Outpatient (β1 = -201.7, 95%CI: -285.4, -117.9) and inpatient (β1 = -372.1, 95% CI: -643.6, -100.6) drug costs for managing PD significantly decreased when implementing ZMDP. However, for outpatients without health insurance, the trend change in drug costs for managing PD (β2 = 16.8, 95% CI: 8.0, 25.6) or PD complications (β2 = 12.6, 95% CI: 5.5, 19.7) significantly increased. Trend changes in outpatient drug costs for managing PD differed when stratifying drugs listed in EML (β2 = -1.4, 95% CI: -2.6, -0.2) or not (β2 = 6.3, 95%CI: 2.0, 10.7). Trend changes of outpatient drug costs for managing PD complications significantly increased in drugs listed in EML (β2 = 14.7, 95% CI 9.2, 20.3), patients without health insurance (β2 = 12.6, 95% CI 5.5, 19.7), and age under 65 (β2 = 24.3, 95% CI 17.3, 31.4).ConclusionsDrug costs for managing PD and its complications significantly decreased when implementing ZMDP. However, the trend in drug costs increased significantly in several subgroups, which may offset the decrease at the implementation.

Project description:IntroductionSweden has long been praised for a generous parental leave policy oriented towards facilitating a gender-equitable approach to work and parenting. Yet certain aspects of Swedish parental leave could also be responsible for the maintenance of (or even the increase in) health inequalities. Using a 'Health in All Policies' lens, this research project aims to assess the unintended health consequences of various components of Sweden's parental leave policy, including eligibility for and uptake of earnings based benefits.Methods and analysisWe will use individual-level data from multiple Swedish registers. Sociodemographic information, including parental leave use, will be retrieved from the total population register, Longitudinal Integration Database for Health Insurance and Labour Market Studies and Social Insurance Agency registers. Health information for parents and children will be retrieved from the patient, prescribed drug, cause of death, medical birth and children's health registers. We will evaluate parents' mental, mothers' reproductive and children's general health outcomes in relation to several policy reforms aiming to protect parental leave benefits in short birth spacing (the speed premium) and to promote father's uptake (the father's quota) and sharing of parental leave days (the double days reform). We will also examine effects of increases in basic parental leave benefit levels. Using quasi-experimental designs, we will compare health outcomes across these reforms and eligibility thresholds with interrupted time series, difference-in-difference and regression discontinuity approaches to reduce the risk of health selection and assess causality in the link between parental leave use and health.Ethics and disseminationThis project has been granted all necessary ethical permissions from the Stockholm Regional Ethical Review Board (Dnr 2019-04913) for accessing and analysing deidentified data. The final outputs will primarily be disseminated as scientific articles published in open-access, high-impact peer-reviewed international journals, as well as press releases and policy briefs.

Project description:ObjectivesIn persons with dementia, polypharmacy may be discordant with the goals of care. It is necessary to design interventions that align treatment regimens with the patient's situation, prognosis and preferences. The objectives of this study conducted at an intermediate care were to: i) identify inappropriate prescribing per the main care goal; ii) compare the pharmacotherapy data pre and post a medication review based on the degree of cognitive impairment; iii) assess the implementation of the proposed prescribing recommendations three months after discharge.DesignPre-post quasi-experimental study.Setting and participantsPatients with dementia discharged from an intermediate care hospital between November 2021 and April 2022.MethodsDemographic, clinical and pharmacotherapy data were evaluated at admission. Medication reviews and interviews with the caregivers were conducted to align pharmacologic therapies with the overall goals of care. At discharge, information on the proposed prescribing recommendations was shared with the primary care team in the discharge summary. Follow up to evaluate implementation of the prescribing recommendations proposed during the medication review was performed at three months.ResultsOf the 97 patients included, 94.8% had at least one inappropriately prescribed medication. At discharge, the mean number of chronic medications taken per patient decreased by 29.6%, from 8.05(SD 3.5) to 5.67(SD 2.7) (p < 0.001); the anticholinergic burden decreased by 18.6%, from 1.59(SD 1.0) to 1.29(SD 0.9) (p < 0.001); and therapeutic complexity decreased by 28.4%, from 29.23(SD 13.8) to 20.94(SD 11.3) (p < 0.001). At 3 months implementation of the proposed prescribing recommendations was 90.0%.Conclusions and implicationsAdmission to an intermediate care hospital provides the ideal setting for a multicomponent intervention, tailoring prescriptions to the patient's overall goals of care and preferences, improving the pharmacotherapy parameters related to side effects, and ensuring that the proposed prescribing recommendations are maintained over the medium term.

Dataset Information

How Did Zero-Markup Medicines Policy Change Prescriptions in the Eyes of Patients?-A Retrospective Quasi-Experimental Analysis.

Background

Objective

Methods

Results

Discussion

Publications

How Did Zero-Markup Medicines Policy Change Prescriptions in the Eyes of Patients?-A Retrospective Quasi-Experimental Analysis.

Similar Datasets

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