Effect of implementing of the medicines zero mark-up policy in Chinese public hospitals: a systematic review_Chinese Journal of Evidence-Based Medicine

Authors：

ZHANG Yuou ¹ , CHENG Hanchao ¹ , WANG Jichao ² ,  SUN Jing ¹ ,  LIU Yuanli ¹

1. School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100710, P.R.China;
2. School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100710, P.R.China;

Corresponding author：

SUN Jing, Email: sunjing@pumc.edu.cn; LIU Yuanli, Email: yliu@pumc.edu.cn

Keywords：

Medicines; Zero mark-up; Public hospital; Effect of implementation; Systematic review

DOI：

10.7507/1672-2531.202011125

Video：

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Objective To systematically review the effect of implementing the medicines zero mark-up policy in Chinese public hospitals.Methods CNKI, WanFang Data, VIP, Sinomed, Web of Science, PubMed and EMbase databases were electronically searched to collect quantitative evaluations of the effect of implementing the medicines zero mark-up policy in Chinese public hospitals from inception to October 30^th, 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Descriptive analysis was then performed.Results The existing evidence on the effect of implementing the medicines zero mark-up policy in Chinese public hospitals was from 3 studies based on national samples and 7 provincial level studies in Beijing, Shannxi and Fujian. After the implementation of the medicines zero mark-up policy, all included studies found that the medicines expenditure and the proportion of medicines expenditure to the total expenditure per outpatient visit or per hospitalization decreased. The expenditures of medical supplies, tests & examinations per outpatient visit or per hospitalization increased, and the medical expenditure per outpatient visit or per hospitalization increased in Beijing. The hospital annual revenue generated from medicines and its proportion to the total annual revenue both decreased across the country. Although the government allocated increased subsidy to compensate the revenue reduction of the public hospitals due to the implementation of the medicines zero-mark-up policy, the total annual revenue of traditional Chinese medicine hospitals at the county level across the country still decreased significantly.Conclusions Based on the available evidence, we conclude that the policy objective of abolishing the mechanism of "compensating medical care with revenue generated from prescribing medicines" is achieved, while that of establishing a scientific compensation mechanism for public hospitals are partially achieved. Compared with other regions, Beijing has appropriately adjusted the prices of medical care while removing the mark-up of medicines, thus is a contributor to the establishment of a scientific compensation mechanism for public hospitals.

Citation： ZHANG Yuou, CHENG Hanchao, WANG Jichao, SUN Jing, LIU Yuanli. Effect of implementing of the medicines zero mark-up policy in Chinese public hospitals: a systematic review. Chinese Journal of Evidence-Based Medicine, 2021, 21(5): 546-558. doi: 10.7507/1672-2531.202011125 Copy

1.	原国家卫生部. 关于医疗机构内部收费问题的原则意见(1954第819号文件, 内部资料). 1954-10-15.
2.	原国家计委. 关于认真贯彻执行药品价格作价有关规定的通知(1998第624号文件, 内部资料). 1998-04-13.
3.	张默, 卞鹰. 我国医院药品价格加成政策的历史回顾及其影响. 中国卫生事业管理, 2007, 23(7): 465-466.
4.	中华人民共和国中央人民政府. 关于进一步整顿药品和医疗服务市场价格秩序的意见的通知, 2006-06-02. Available at: http://www.gov.cn/zwgk/2006-06/02/content_298610.htm.
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1. 原国家卫生部. 关于医疗机构内部收费问题的原则意见(1954第819号文件, 内部资料). 1954-10-15.
2. 原国家计委. 关于认真贯彻执行药品价格作价有关规定的通知(1998第624号文件, 内部资料). 1998-04-13.
3. 张默, 卞鹰. 我国医院药品价格加成政策的历史回顾及其影响. 中国卫生事业管理, 2007, 23(7): 465-466.
4. 中华人民共和国中央人民政府. 关于进一步整顿药品和医疗服务市场价格秩序的意见的通知, 2006-06-02. Available at: http://www.gov.cn/zwgk/2006-06/02/content_298610.htm.
5. 中华人民共和国中央人民政府. 关于深化医药卫生体制改革的意见, 2009-04-06. Available at: http://www.gov.cn/jrzg/2009-04/06/content_1278721.htm.
6. 中华人民共和国中央人民政府. 关于印发医药卫生体制改革近期重点实施方案(2009-2011年)的通知, 2009-03-18.Available at: http://www.nhc.gov.cn/tigs/s3576/201309/579e6ab479a4497c98c362c778f977ae.shtml.
7. 中华人民共和国国务院办公厅. 关于印发2011年公立医院改革试点工作安排的通知, 2011-03-07. Available at: http://www.gov.cn/zwgk/2011-03/07/content_1818279.htm.
8. 中华人民共和国中央人民政府. 关于印发“十二五”期间深化医药卫生体制改革规划暨实施方案的通知, 2012-03-21. Available at: http://www.gov.cn/zwgk/2012-03/21/content_2096671.htm.
9. 中华人民共和国国务院办公厅. 关于印发深化医药卫生体制改革2012年主要工作安排的通知, 2012-04-18. Available at: http://www.gov.cn/zwgk/2012-04/18/content_2115928.html.
10. 中华人民共和国中央人民政府. 关于县级公立医院综合改革试点意见的通知, 2012-06-14. Available at: http://www.gov.cn/zwgk/2012-06/14/content_2161153.htm.
11. 中华人民共和国中央人民政府. 关于印发推进县级公立医院综合改革意见的通知, 2014-04-08. Available at: http://www.gov.cn/xinwen/2014-04/08/content_2654774.htm.
12. 中华人民共和国中央人民政府. 关于印发深化医药卫生体制改革2014年重点工作任务的通知, 2014-05-28. Available at: http://www.gov.cn/zhengce/content/2014-05/28/content_8832.htm.
13. 中华人民共和国国务院办公厅. 关于印发深化医药卫生体制改革2014年工作总结和2015年重点工作任务的通知, 2015-05-09. Available at: http://www.gov.cn/zhengce/content/2015-05/09/content_9716.htm.
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17. Sterne JA, Hernán MA, Reeves BC, et.al ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ, 2016, 355: i4919.
18. 周忠良, 苏延芳, 周志英, 等. 基本药物“零差率”政策对住院费用的影响—基于陕西省县级公立医院的研究. 中国卫生政策研究, 2013, 6(12): 25-32.
19. 周雅婷. 北京取消药品加成政策对某三甲医院经济运行质量的影响研究. 中国卫生政策研究, 2020, 13(6): 21-26.
20. 王俊锋, 崔斌, 魏霞, 等. 北京市医药分开综合改革对服务利用的影响—以缺血性心脏病住院患者为例. 中国卫生政策研究, 2019, 12(11): 45-52.
21. 王俊锋, 陈正超, 崔斌, 等. 北京市医药分开政策对住院费用的影响—以五家试点医院为例. 中国卫生政策研究, 2018, 11(7): 42-48.
22. Wei X, Yin J, Walley JD, et al. Impact of China's essential medicines scheme and zero-mark-up policy on antibiotic prescriptions in county hospitals: a mixed methods study. Trop Med Int Health, 2017, 22(9): 1166-1174.
23. Shi X, Zhu D, Man X, et al. "The biggest reform to China's health system": did the zero-markup drug policy achieve its goal at traditional Chinese medicines county hospitals? Health Policy Plan, 2019, 34(7): 483-491.
24. 王天奇, 郭默宁, 路凤, 等. 北京两项改革措施的实施对医疗机构门急诊患者就医流向影响的研究. 中国卫生信息管理杂志, 2020, 17(2): 131-135, 206.
25. 卢铭, 郭岩. 北京市医药分开改革对试点医院医保住院费用的影响. 中国医疗保险, 2014, (11): 49-51.
26. 路凤, 王天奇, 臧白, 等. 北京市医药分开和医耗联动综合改革对医疗费用影响分析. 中华医院管理杂志, 2020, 36(7): 544-548.
27. 冷家骅, 刘忆, 陈治水, 等. 北京市医药分开综合改革对肿瘤专科医院的影响—基于北京某肿瘤医院医保数据的实证分析. 中国卫生政策研究, 2017, 10(12): 15-21.
28. 乔琛, 雷海潮. 基于效率与可及性视角的北京市医药分开综合改革效果评价. 解放军医院管理杂志, 2020, 27(6): 559-563.
29. 邓明, 张柠. 医药分开综合改革对三级医院门急诊患者医疗费用影响的分析. 中国卫生统计, 2019, 36(6): 860-862.
30. Liu X, Xu J, Yuan B, et al. Containing medical expenditure: lessons from reform of Beijing public hospitals. BMJ, 2019, 365: l2369.
31. He Y, Dou G, Huang Q, et al. Does the leading pharmaceutical reform in China really solve the issue of overly expensive healthcare services? Evidence from an empirical study. PLoS One, 2018, 13(1): e0190320.
32. Wang X, Li F, Wang X, et al. Effects of different mark-up drug policies on drug-related expenditures in tertiary public hospitals: an interrupted time series study in Shanghai, China, 2015-2018. Biosci Trends, 2020, 14(1): 16-22.
33. Wang J, Li P, Wen J. Impacts of the zero mark-up drug policy on hospitalization expenses of COPD inpatients in Sichuan province, western China: an interrupted time series analysis. BMC Health Serv Res, 2020, 20(1): 519.
34. Nie Z, Man C, Yin H, et al. Impact of the zero-markup drug policy on volume of medical service: based on 57 county hospitals of China. J Chin Pharmaceut Sci, 2020, 29(3): 220-226.
35. 周书铎, 庄昱, 杨朔, 等. 北京市医药分开综合改革对门急诊患者就医流向的影响研究. 中国卫生政策研究, 2018, 11(7): 37-41.
36. 周忠良, 周志英, 禹强, 等. 基本药物“零差率”对陕西省县级医院非手术病种费用的影响: 基于不同分析方法的对比研究. 中国卫生经济, 2014, 33(8): 67-69.
37. 庄昱, 董书, 吴昕霞. 北京市医药分开综合改革对某三级综合医院门诊服务利用的影响. 医学与社会, 2020, 33(2): 53-57.
38. 李春厚, 杨丽, 冯雅慧, 等. 北京市医药分开综合改革下参保人群门诊经济负担研究. 中华医院管理杂志, 2020, 36(3): 188-192.
39. Fu H, Li L, Yip W. Intended and unintended impacts of price changes for drugs and medical services: Evidence from China. Soc Sci Med, 2018, 211: 114-122.
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Chinese Journal of Evidence-Based Medicine

Effect of implementing of the medicines zero mark-up policy in Chinese public hospitals: a systematic review

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