The impact of National Volume-Based Procurement policy on healthcare expenditure and provider behavior in China

Abstract

To curb rising medical expenses, the Chinese government launched a national volume-based procurement (NVBP) policy for high-value medical consumables. This study evaluates its impact on coronary stents, the first targeted category implemented in 2021. Using inpatient records for all percutaneous coronary intervention (PCI) patients in a large pilot city and a time regression discontinuity design, we examined effects on healthcare expenditures, care intensities, treatment outcomes, service volume, and treatment patterns. The results showed a significant 35.2 % decrease in average total expenditure, primarily driven by a 65.4 % reduction in medical supplies and consumables fees. However, the policy also led to unintended provider responses, including increased stents implanted per patient, a 43.3 % rise in weekly service volume, and a higher likelihood of using alternative, costlier treatment patterns. No significant impact was found on 30-day readmissions, but a slight increase in in-hospital mortality was observed. Importantly, analysis by insurance status revealed distinct provider strategies: expanding PCI volume for higher-coverage patients and increasing stent use per procedure for lower-coverage patients. Dynamic analysis indicated sustained reductions in expenditures over time, though effects on care intensities diminished after a few months. These findings suggest that while NVBP effectively reduced patient-level healthcare expenditures, it raised concerns about its broader impact on aggregate healthcare spending and provider behavior.