The impact of comprehensive public hospital reform on economic burden of inpatients with chronic obstructive pulmonary disease: evidence from a pilot city in western China.

IF 1.8 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Expert Review of Pharmacoeconomics & Outcomes Research Pub Date : 2025-03-15 DOI:10.1080/14737167.2025.2480123

Yanghaotian Wu, Jingfu Qiu

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Abstract

Background: The Chinese government launched a comprehensive reform of public hospitals, including a zero-markup drug policy (ZMDP) and adjustments to the price compensation mechanism for medical services. We aimed to assess the impact of the reform on economic burden for chronic obstructive pulmonary disease (COPD) inpatients.

Research design and methods: Health care institutions were selected using judgmental sampling. Structural variation analysis was conducted to assess changes in the cost structure. An interrupted time series analysis was used to evaluate level and trend changes in medical costs.

Results: After the reform, the total cost, western medicine cost, and traditional Chinese medicine cost per visit decreased significantly, with monthly downward trends (p < 0.05). The proportion of western medicine cost decreased by 5.59%, but remained the main composition (31.78%). The health insurance payments, out-of-pocket (OOP) cost per visit, and OOP cost proportion decreased significantly (p < 0.05). The health insurance payments per visit showed a monthly downward trend (p < 0.001), and the decline in OOP cost per visit extended (p = 0.003).

Conclusions: The reform reduced the economic burden of COPD inpatients, optimized the cost structure and improved the efficiency of health insurance utilization. However, the short-term substitution effect of medical services on medicines weakened the cost-reduction effect.

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公立医院综合改革对慢性阻塞性肺疾病住院患者经济负担的影响——来自西部某试点城市的证据

背景：中国政府启动了公立医院的全面改革，包括药品零加价政策和医疗服务价格补偿机制的调整。我们的目的是评估改革对慢性阻塞性肺疾病（COPD）住院患者经济负担的影响。研究设计与方法：采用判断抽样法选择卫生保健机构。进行结构变化分析以评估成本结构的变化。采用中断时间序列分析评价医疗费用的水平和趋势变化。结果：改革后总费用、西药费用、中药费用均显著下降，且呈逐月下降趋势（p p p p = 0.003）。结论：改革减轻了慢性阻塞性肺病住院患者的经济负担，优化了成本结构，提高了医保利用效率。然而，医疗服务对药品的短期替代效应削弱了成本降低效应。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Expert Review of Pharmacoeconomics & Outcomes Research HEALTH CARE SCIENCES & SERVICES-PHARMACOLOGY & PHARMACY

CiteScore

4.00

自引率

4.30%

发文量

审稿时长

6-12 weeks

期刊介绍： Expert Review of Pharmacoeconomics & Outcomes Research (ISSN 1473-7167) provides expert reviews on cost-benefit and pharmacoeconomic issues relating to the clinical use of drugs and therapeutic approaches. Coverage includes pharmacoeconomics and quality-of-life research, therapeutic outcomes, evidence-based medicine and cost-benefit research. All articles are subject to rigorous peer-review. The journal adopts the unique Expert Review article format, offering a complete overview of current thinking in a key technology area, research or clinical practice, augmented by the following sections: Expert Opinion – a personal view of the data presented in the article, a discussion on the developments that are likely to be important in the future, and the avenues of research likely to become exciting as further studies yield more detailed results Article Highlights – an executive summary of the author’s most critical points.