| ObjectivesThe purpose of the study is to analyze the effect of the drug zero-profit policy implemented on July 15,2017 in Guangzhou on the medical expenses and antiviral treatment compliance of patients with Chronic Hepatitis B(CHB)related diseases in a public liver specialist hospital in Guangzhou,so as to provide reference for the government to supplement and improve relevant health policies.MethodsIn this study,an electronic case database of a public liver specialist hospital in Guangzhou was used as the data source.Retrospectively collected the medical information,direct medical cost information,and prescription information of outpatient and inpatient CHB-related disease(CHB and Cirrhosis)from July 15,2016 to July 15,2018.Describe the cost structure of outpatients and inpatients before and after the implementation of the different payment methods(self-pay or medical insurance),and approximate normal test was used to analyze the average monthly expenses before and after the implementation of outpatient policies for different payment methods(self-pay or medical insurance)and the various average expenses before and after the implementation of inpatient policies;in order to find changes in trends,the Interrupted Timeseries method was used to compare the impact of before and after the implementation of the policy on the average monthly cost of different payment methods(self-pay or medical insurance)outpatients and the average per-time cost of inpatients and the length of hospital stay;Multinomial logistic regression models were used to analyze the influencing factors of adherence with antiviral therapy in outpatients with CHB.Data were analyzed using SAS9.4.Results(1)After the implementation of the drugs zero-profit policy,the cost structure of patients with CHB patients or Cirrhosis with different payment methods in outpatient clinics had changed.Among them,the proportion of western medicine costs has decreased slightly,and the proportion of inspection fees and other expenses had increased.(2)After the implementation of the drugs zero-profit policy,the cost structure of CHB patients and patients with liver cirrhosis who were hospitalized with different payment methods had changed.The proportion of western medicine expenses of patients had slightly decreased,while the proportion of examination fees,bed care fees,treatment fees and other expenses had slightly increased.(3)After the implementation of the drugs zero-profit policy,in outpatients,for CHB medical insurance patients,the average monthly total cost,the average monthly western medicine cost,the average monthly antiviral drugs cost,and the average monthly other western medicines cost were lower than before the implementation of the policy,which were reduced by 109.13,120.98,107.52 and 13.46 RMB,respectively;the average monthly examination cost and monthly other costs were higher than before the implementation of the policy,which were increase 1.18 and 20.55 RMB,respectively.For outpatient CHB at their own expense,the average monthly total cost,the average monthly western medicine cost,the average monthly antiviral drugs cost,and the average monthly other western medicines cost were all lower than before the implementation of the policy,which were reduced by 183.08,187.77,149.35 and 38.41 RMB;the average monthly examination cost and other monthly cost were higher than before the implementation of the policy,which were increase 3.08 and 28.98 RMB,respectively.For Cirrhosis medical insurance patients,the average monthly total cost,the average monthly western medicine cost,and the average monthly antiviral drug cost were lower than before the implementation of the policy,and were reduced by 170.75,179.10 and 170.95 RMB,respectively;other monthly cost and the average monthly examination cost were higher than before the implementation of the policy,which were 3.01 and 32.45 RMB,respectively;The average monthly total cost,average monthly western medicine cost,average monthly antiviral medicine cost,and average monthly other western medicine cost of Cirrhosis self-pay patients were lower than before the implementation of the policy,which were reduced by 254.82,211.11,179.77 and 31.34 RMB and the average monthly other cost was higher than before the implementation of the policy,which was 34.05 RMB higher.(4)The analysis of the Interrupted Time-series method shows that the implementation of the drugs zero-profit policy had reduced the average monthly other western medicines cost and the average monthly other cost for CHB medical insurance patients and Cirrhosis medical insurance patients in outpatient;the average monthly other western medicines cost for CHB self-pay patients and Cirrhosis self-pay patients in outpatient was decreased,while the monthly average examination cost was increased.In addition,the implementation of the policy had little effect on the average monthly total cost and average monthly antiviral drugs cost of CHB patients and Cirrhotic patients for different payment methods in outpatient.(5)After the implementation of the drugs zero-profit policy,the average per-time western medicines cost and average per-time antiviral drugs cost for CHB medical insurance patients on inpatient were lower than before the implementation of the policies,which were decreased by 44.63 and 299.44 RMB,respectively;average per-time bed care fee,average per-time treatment cost and average per-time other cost were higher than before the implementation of the policy,which were increased 640.03,373.23,319.37 and 435.78 RMB,respectively.The average pertime western medicines cost,average per-time antiviral medicines cost,and average per-time other western medicines cost of CHB self-pay on inpatient were lower than before the implementation of the policy,and were decreased by 1435.81,585.09 and 850.71 RMB;average per-time examination cost,average per-time bed care fees,average per-time treatment cost and average per-time other cost are higher than before the implementation of the policy,respectively were higher than 475.50,258.56,115.34 and 268.24 RMB.For Cirrhosis medical insurance patients on inpatient,the average per-time western medicine cost,average per-time antiviral medicine cost and average per-time other western medicine cost were lower than before the implementation of the policy,which decreased by 1037.27,164.47 and 872.80 RMB;average per-time examination cost,average per-time bed care fee and average per-time other cost were higher than before the implementation of the policy,which were higher than 344.76,298.80 and 82.78 RMB.For Cirrhosis self-pay patients on inpatient,the average per-time western medicine cost,average per-time antiviral medicine cost and average per-time other western medicine cost were lower than before the implementation of the policy,which decreased by 1413.98,566.24 and 847.74 RMB,respectively;the average per-time examination cost,average per-time bed care fees,and average per-time treatment cost were higher than before the policy implementation,which were increased by 482.06,346.26 and 140.31 RMB.(6)Analysis of the Interrupted Time-series method shows that after the implementation of the drugs zero-profit policy,for CHB medical insurance patients on inpatient,the average per-time total cost,average pertime western drug cost,average per-time antiviral drug cost,and average per-time other western drug cost were decreased by 339.97,245.70,11.13 and 233.60 RMB,respectively;the average per-time cost of bed care,average per-time treatment and average per-time other cost were decreased by 38.73,51.88,and 27.98 RMB,respectively.For CHB self-pay patients on inpatient,the average per-time total cost,the average per-time cost of other western medicines,the average per-time cost of bed care,the average per-time treatment cost,and other per-time cost were decreased by 631.38,438.44,53.24,19.72 and 76.26 RMB,respectively.The average per-time examination cost for Cirrhosis medical insurance on inpatient was increased by an average of 61.77 RMB.For Cirrhosis self-pay patients on inpatient,the average per-time total cost,average per-time western drug cost,average per-time antiviral drug cost,average per-time other western drug cost,average per-time bed care cost,average per-time treatment cost,and average per-time other cost were dropped by 631.38,338.69,24.77,314.26,29.53,86.82 and 74.03 RMB.The average length of stay in patients with CHB and Cirrhosis with different payment methods decreased to some extent.(7)Before and after the implementation of the drugs zero-profit policy,both the outpatient CHB and Cirrhosis patients,the average monthly total cost of medical insurance patients was lower than that of self-pay patients,and average monthly western medicine costs was higher than self-pay patients.After the implementation of the policy,the per-time total cost of inpatients with Cirrhosis medical insurance was higher than that of selfpay patients,and the difference was statistically significant;while the pertime total cost of inpatients CHB medical insurance patients was not different from that of CHB self-pay patients.(8)After the implementation of the drugs zero-profit policy,the compliance of antiviral drug use in outpatients with CHB was significantly improved than before the implementation of the drugs zero-profit policy(OR=1.409,95%CI:1.153,1.721);Meanwhile,the HBeAg positive outpatient who compliance of antiviral use among patients treated was higher than that of patients treated with HBeAg-negative outpatient CHB(OR=1.231,95% CI: 1.000,1.514).Conclusions1.The implementation of the drugs zero-profit policy maybechanged the cost structure of outpatients;the average monthly total cost and average monthly antiviral drug cost of patient with CHB or Cirrhosis who had different payment methods in the outpatient were not affected by the policy;the implementation of the policy reduced the average monthly cost of other western medicines for patients.2.The implementation of the drugs zero-profit policy maybe changed the structure of the cost structure of inpatients,and it could reduce the inpatients with CHB insurance or self-pay and Cirrhosis self-pay patients the average per-time total cost,the average per-time cost of other western medicines,the average per-time cost of bed care,the average per-time treatment cost,and the average per-time of other cost.In addition,the implementation of the policy maybe shortened the number of hospital stays for all types of patients.3.After the implementation of the drugs zero-profit policy,the adjustment of the cost structure may result in the unreasonable increase of the average monthly examination cost of some outpatients(such as outpatients with CHB or Cirrhosis at their own expense)and may increase the cost of per examination for some inpatients,such as Cirrhosis medical insurance inpatients.4.After the implementation of the drugs zero-profit policy,the medical insurance system would help to control the increase of medical expenses for outpatient medical insurance patients to a certain extent,but it may stimulate the demand for medical services for inpatients with inpatient Cirrhosis medical insurance.5.The implementation of the drugs zero-profit policy has improved the compliance of outpatient CHB treated patients with antiviral drugs.The compliance of HBeAg positive patients with antiviral drugs is better than that of HBeAg negative patients.Suggestion1.Improve internal management of public hospitals;2.Strengthen the supervision of public hospitals3.Relevant government departments should continue to improve relevant supporting policies and measures4.The medical insurance department should strengthen the supervision of medical services and standardize the clinical path. |
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