scholarly journals Impact of the zero-mark-up drug policy on drug-related expenditures and use in public hospitals, 2016–2018: an interrupted time series study in Shaanxi

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e037034
Author(s):  
Kangkang Yan ◽  
Caijun Yang ◽  
Hongli Zhang ◽  
Dan Ye ◽  
Shengyuan Liu ◽  
...  
Keyword(s):  
Time Series ◽  
Drug Policy ◽  
Interrupted Time Series ◽  
Public Hospitals ◽  
Medical Expenditures ◽  
Shaanxi Province ◽  
Increasing Trend ◽  
Tertiary Hospitals ◽  
Drug Expenditures ◽  
Outpatient Drug

ObjectiveThe aim of this study was to measure the impact of zero-mark-up drug policy (ZMDP) on drug-related expenditures and use in urban hospitals.DesignThis was a retrospective observational study of trends in drug expenses and use in the context of the ZMDP using an interrupted time series analysis.SettingTwelve hospitals (three tertiary hospitals and nine secondary hospitals) in Xi’an, which is the capital of Shaanxi Province in Western China.Data and participantsThe prescription information for all outpatients and inpatients in the study hospitals from January 2016 to April 2018 was used in this study.InterventionsThe Chinese government announced the policy intervention measure of the ZMDP, which was implemented in all public hospitals as of 1 April 2017.Primary measuresMonthly drug expenditures, monthly medical expenditures, the percentage of drug expenditures among total medical expenditures, the average outpatient drug expenditure per visit, the percentage of prescriptions that include an injection and the percentage of prescriptions that include an antibiotic.ResultsMonthly total medical expenses increased in both tertiary and secondary hospitals after the ZMDP was implemented. In tertiary hospitals, the average outpatient drug expenditures per visit showed a slow decreasing trend before the intervention and an increasing trend after the intervention, with statistically significant changes in both the level (p<0.001) and the trend (p=0.02). Secondary hospitals showed a slow increasing trend both before and after the policy implementation, with no significant change in the trend (p=0.205). The proportion of prescriptions, including injections, was over 20% in secondary hospitals and less than 20% in tertiary hospitals, with no significant changes to this indicator observed after implementation of ZMDP.ConclusionsThe effect of the ZMDP on drug-related expenditures and use in Chinese public hospitals was not substantially evident. Future pharmaceutical reform measures should give more consideration to physician prescription behaviours.

scholarly journals Did the universal zero-markup drug policy lower healthcare expenditures? Evidence from Changde, China

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zixuan Peng ◽  
Chaohong Zhan ◽  
Xiaomeng Ma ◽  
Honghui Yao ◽  
Xu Chen ◽  
...  
Keyword(s):  
Healthcare Utilization ◽  
Drug Policy ◽  
Negative Binomial ◽  
Public Hospitals ◽  
Hunan Province ◽  
Healthcare Expenditures ◽  
Discharge Data ◽  
Outpatient Visits ◽  
Drug Expenditures ◽  
Outpatient Drug

Abstract Background The zero-markup drug policy (also known as the universal zero-markup drug policy (UZMDP)) was implemented in stages beginning with primary healthcare facilities in 2009 and eventually encompassing city public hospitals in 2016. This policy has been a central pillar of Chinese health reforms. While the literature has examined the impacts of this policy on healthcare utilization and expenditures, a more comprehensive and detailed assessment is warranted. The purpose of this paper is to explore the impacts of the UZMDP on inpatient and outpatient visits as well as on both aggregate healthcare expenditures and its various components (including drug, diagnosis, laboratory, and medical consumables expenditures). Methods A pre-post design was applied to a dataset extracted from the Changde Municipal Human Resource and Social Security Bureau comprising discharge data on 27,246 inpatients and encounter data on 48,282 outpatients in Changde city, Hunan province, China. The pre-UZMDP period for the city public hospitals was defined as the period from October 2015 to September 2016, while the post-UZMDP period was defined as the period from October 2016 to September 2017. Difference-in-Difference negative binomial and Tobit regression models were employed to evaluate the impacts of the UZMDP on healthcare utilization and expenditures, respectively. Results Four key findings flow from our assessment of the impacts of the UZMDP: first, outpatient and inpatient visits increased by 8.89 % and 9.39 %, respectively; second, average annual inpatient and outpatient drug expenditures fell by 4,349.00 CNY and 1,262.00 CNY, respectively; third, average annual expenditures on other categories of healthcare expenditures increased by 2,500.83 CNY, 417.10 CNY, 122.98 CNY, and 143.50 CNY for aggregate inpatient, inpatient diagnosis, inpatient laboratory, and outpatient medical consumables expenditures, respectively; and fourth, men and older individuals tended to have more inpatient and outpatient visits than their counterparts. Conclusions Although the UZMDP was effective in reducing both inpatient and outpatient drug expenditures, it led to a sharp rise in other expenditure categories. Policy decision makers are advised to undertake efforts to contain the growth in total healthcare expenditures, in general, as well as to evaluate the offsetting effects of the policy on non-drug components of care.

Has the SARS-CoV-2 outbreak had an impact on uptake of digital cessation support in UK smokers? An interrupted time series analysis (Preprint)

2020 ◽  
Author(s):  
Olga Perski ◽  
Aleksandra Herbec ◽  
Lion Shahab ◽  
Jamie Brown
Keyword(s):  
Time Series ◽  
Smoking Cessation ◽  
Secondary Analysis ◽  
Interrupted Time Series ◽  
Step Change ◽  
Outcome Variable ◽  
Primary Analysis ◽  
Increasing Trend ◽  
The Uk ◽  
Temporary Closure

BACKGROUND The SARS-CoV-2 outbreak may motivate smokers to attempt to stop in greater numbers. However, given the temporary closure of UK stop smoking services and vape shops, smokers attempting to quit may instead seek out digital support, such as websites and smartphone apps. OBJECTIVE We examined, using an interrupted time series approach, whether the SARS-CoV-2 outbreak has been associated with a step change or increasing trend in UK downloads of an otherwise popular smoking cessation app, Smoke Free. METHODS Data were from daily and non-daily adult smokers in the UK who had downloaded the Smoke Free app between 1 January 2020 and 31 March 2020 (primary analysis) and 1 January 2019 and 31 March 2020 (secondary analysis). The outcome variable was the number of downloads aggregated at the 12-hourly (primary analysis) or daily level (secondary analysis). The explanatory variable was the start of the SARS-CoV-2 outbreak, operationalised as 1 March 2020 (primary analysis) and 15 January 2020 (secondary analysis). Generalised Additive Mixed Models adjusted for relevant covariates were fitted. RESULTS Data were collected on 45,105 (primary analysis) and 119,881 (secondary analysis) users. In both analyses, there was no evidence for a step change or increasing trend in downloads attributable to the start of the SARS-CoV-2 outbreak. CONCLUSIONS In the UK, between 1 January 2020 and 31 March 2020, and between 1 January 2019 and 31 March 2020, there was no evidence that the SARS-CoV-2 outbreak has been associated with a surge in downloads of a popular smoking cessation app. CLINICALTRIAL osf.io/zan2s

scholarly journals Impact of the Expert Consensus on Carbapenem Consumption Trends and Patterns in Public Healthcare Institutes: An Interrupted Time Series Analysis, 2017–2020

2022 ◽  
Vol 12 ◽  
Author(s):  
Dan Ye ◽  
Caijun Yang ◽  
Wenjing Ji ◽  
Jie Zheng ◽  
Jingyi Zhang ◽  
...  
Keyword(s):  
Time Series ◽  
Time Series Analysis ◽  
Positive Impact ◽  
Interrupted Time Series ◽  
Expert Consensus ◽  
Shaanxi Province ◽  
Public Healthcare ◽  
Interrupted Time Series Analysis ◽  
Series Analysis

Background: Carbapenems are considered the last line of defence against bacterial infections, but their high consumption and the resulting antibacterial resistance are an increasing global concern. In this context, the Chinese health authority issued an expert consensus on the clinical applications of carbapenems. However, the long- and short-term effects of the expert consensus on carbapenem use are not clear.Methods: This study was conducted in Shaanxi, a northwest province of China. We collected all available carbapenem procurement data between January 2017 and December 2020 from the Provincial Drug Centralized Bidding Procurement System. A quasi-experimental interrupted time series analysis was used to evaluate the longitudinal effectiveness of expert consensus by measuring the change in the Defined Daily Dosesper 1,000 inhabitants per day (DID), the percentage of carbapenem expenditures to total antimicrobial expenditure, the total carbapenem expenditure, and the defined daily cost (DDDc). We used Stata SE version 15.0 for data analysis, and p &lt; 0.05 was considered statistically significant.Results: After the distribution of the expert consensus, the level (p = 0.769) and trend (p = 0.184) of DID decreased, but the differences were not statistically significant. The percentage of carbapenem expenditures to total antimicrobial expenditure decreased abruptly (p &lt; 0.001) after the intervention, but the long-term trend was still upward. There was no statistically significant relationship between the release of the expert consensus and carbapenem expenditure in the long term, but there was a decreasing trend (p = 0.032). However, the expert consensus had a positive impact on the economic burden of carbapenem usage in patients, as the level (p &lt; 0.001), and trend (p = 0.003) of DDDc significantly decreased.Conclusion: The long-term effects of the distribution of the expert consensus on the use and expenditure of carbapenems in public health institutions in Shaanxi Province were not optimal. It is time to set up more administrative measures and scientific supervision to establish a specific index to limit the application of carbapenems.

scholarly journals Impact of China’s healthcare price reforms on traditional Chinese medicine public hospitals in Beijing: an interrupted time-series study

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e029646 ◽  
Author(s):  
Dawei Zhu ◽  
Xuefeng Shi ◽  
Stephen Nicholas ◽  
Qian Bai ◽  
Ping He
Keyword(s):  
Time Series ◽  
Chinese Medicine ◽  
Traditional Chinese Medicine ◽  
Medical Service ◽  
Outpatient Visit ◽  
Herbal Medicines ◽  
Interrupted Time Series ◽  
Inpatient Admission ◽  
Outpatient Visits ◽  
Drug Expenditures

ObjectiveTo evaluate the 2017 implementation of China’s 2009 healthcare price reforms on Beijing’s secondary and tertiary traditional Chinese medicine (TCM) hospitals.DesignWe employed a panel-interrupted time-series model with hospital fixed effects to estimate the impact of the price reforms.SettingBeijing, April 2014 to April 2018.ParticipantsAll TCM hospitals in Beijing.Outcome measuresOur dependent variables comprised the monthly outpatient and inpatient revenues, the number of monthly outpatient visits and inpatient admissions, the average total expenditures per outpatient visit and per inpatient admission, the average drug expenditures (except herbal medicines) per outpatient visit and per inpatient admission and the average medical service expenditures per outpatient visit and per inpatient admission.ResultsIn tertiary hospitals, the price reforms led to significant reductions in the number of outpatient visits (23.1%), inpatients admission (4.6%) and drug expenditures (except herbal medicines) per inpatient admission (14.0%), and an instant raise in average total expenditure per outpatient (22.0%), medical service expenditures per outpatient visit (58.2%) and inpatient admission (19.0%). There was no significant association between the price reforms and the monthly outpatient and inpatient revenues. After the price reforms, the previous upward trend in medical service expenditures per outpatient visit rose more sharply (from 0.5% to 1.6%). In secondary hospitals, the price reforms decreased the level of drug expenditures (except herbal medicines) per outpatient visit (13.0%) and per inpatient admission (20.8%), but increased medical service expenditures per inpatient admission by 19.0%.ConclusionThe Beijing price reforms adjusted the cost structures in secondary and tertiary TCM hospitals without negatively impacting the operation of the hospitals, and through the increased hierarchical medical service fee, shifted patient choices away from tertiary to other health facilities, especially for patients with minor illnesses.

scholarly journals Impact of the Low-Price Medicine Policy on Medicine Supply in China: An Interrupted Time-Series Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Mingyue Zhao ◽  
Ali Hassan Gillani ◽  
Duan Ji ◽  
Zhitong Feng ◽  
Yu Fang ◽  
...  
Keyword(s):  
Growth Rate ◽  
Time Series ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Average Growth Rate ◽  
Average Growth ◽  
Total Group ◽  
Increasing Trend ◽  
Trend Coefficient ◽  
The Impact

Objectives: The primary objective of the study was to assess the impact of the Low-Price Medicine Policy (LPMP) on the supply of low-price medicines (LPMs) in China. The secondary objective of the study was to describe the supply situation of LPMs from 2005 to 2018.Methods: The LPMP was launched in the third quarter of 2014 (2014Q3). An interrupted time series analysis was used to evaluate the impact of LPMP on the supply of LPMs in China. Ordinary least squares and Poisson regression models were utilized to estimate the effect of LPMP on LPMs’ supply growth rate and the number of supplied LPMs. All the LPMs were divided into two subgroups: intermittent supply and continuous supply. The trend and level changes of the quarterly average growth rate and number of quarterly supplies for different LPM groups were analyzed from 2005 to 2018.Findings: For the quarterly average growth rate, before the intervention, a significant increasing trend was observed in the total group and the continuous supply subgroup; after the introduction of LPMP, the increasing trend was ceased and a significant decrease in the trend and level was noted for both the total group (trend coefficient: β3= −0.0132, p &lt; 0.01; level coefficient: β2 = −0.1510, p &lt; 0.05) and the continuous supply subgroup (trend coefficient: β3 = −0.0133, p &lt; 0.01; level coefficient: β2 = −0.1520, p &lt; 0.05); whereas it had no significant effect for intermittent supply subgroup. For the number of quarterly supplies, after the intervention of LPMP, decline of the supply number was observed (trend coefficient: β3 = −0.0027, p &lt; 0.001; level coefficient: β2 = −0.0584, p &lt; 0.001); whereas the LPMP was associated with an upward trend and level (trend coefficient: β3 = 0.0715, p &lt; 0.001; level coefficient: β2 = 0.174) for the intermittent supply subgroup.Conclusion: For most of the LPMs, LPMP did not meet the goal of stimulating LPM production. However, for severely shortage medicines (the intermittent supply subgroup), the effect of LPMP was positive. Comprehensive policies rather than just deregulating medicine price should be introduced to alleviate the situation of medicine shortage in China.

scholarly journals Effects of Chinese Medical Pricing Reform on the Structure of Hospital Revenue and Healthcare Expenditure in County Hospital: An Interrupted Time Series Analysis

2021 ◽  
Author(s):  
Mengling Liu ◽  
Mingyuan Jia ◽  
Qian Lin ◽  
Jiawei Zhu ◽  
Dong Wang
Keyword(s):  
Time Series ◽  
Healthcare Expenditure ◽  
Financial Burden ◽  
Interrupted Time Series ◽  
Public Hospitals ◽  
Interrupted Time Series Analysis ◽  
Monthly Data ◽  
Hospital Revenue ◽  
Main Components ◽  
Interrupted Time Series Design

Abstract Background China has initiated a medical pricing reform to combat the overuse of drugs and relieve the financial burden of patients. This paper aims to analyze the effect of medical pricing reform on revenue structure and healthcare expenditure of county public hospitals in Guangdong province. Methods Based on the monthly data from January 2013 to August 2019, we use interrupted time series design to evaluate the effects of medical pricing reform on healthcare expenditure in both outpatients and inpatients. A counterfactual is also established to examine the net effect of the policy. Results The proportion of drug revenue decreased from 35% in 2015 to 29.7% in 2019, and the revenue from medical services and inspection increased 3.2% and 3% respectively. Meanwhile, the increasing trend of total expenditure and its main components is slowed down, especially the drug expense and medical consumable expense for inpatients after the Zero Mark-up Drug policy. However, the growth of inspection expense for outpatients continues to increase, while the healthcare expenditure for inpatients experiences an instant increase after the Zero Mark-up Medical Consumables policy. Conclusion The medical pricing reform is a valuable attempt in controlling the unreasonable increase of medical expenses. In the meantime, the unexpected increase in inspection expenditure and insufficient compensation from medical service adjustment should draw the attention of the policymakers.

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