Comparative Analysis Of The Hospitalization Expenses Of Patients With Major Chronic Diseases In A City Before And After The Implementation Of Abolition Of Drug Mark-up Policy

Objectives This study analyzed the hospitalization expenses of patients with major chronic diseases of a city before and after the implementation of abolition of drug mark-up policy to understand the basic situation of patients with chronic diseases and the composition of hospitalization expenses and medical insurance expenses before and after the implementation of abolition of drug mark-up policy.On this basis,this study evaluated the influence of the abolition of drug mark-up policy on the hospitalization expenses for patients with major chronic diseases by analyzing the changes of hospitalization expenses and medical insurance expenses for patients with chronic diseases before and after the implementation of abolition of drug mark-up policy,so as to provide empirical data support and policy suggestions for relevant government departments to reform the pharmaceutical and health care system.Methods This study is a retrospective study,and the data were obtained from the medical insurance settlement system of the medical insurance bureau of the city,from which the settlement data of inpatients in seven municipal public tertiary hospitals in a city from January 19,2015 to November 20,2018 were obtained,and the demographic information,treatment information and expenses information of stroke,chronic obstructive pulmonary disease（COPD）,type 2 diabetes（T2DM）and tuberculosis（chronic infectious disease）inpatients before and after the implementation of the policy were collected by taking December 18,2016 as the policy intervention point.By reviewing the domestic and foreign policies on drug price management,especially relevant literature on changes in medical insurance funds and patients’ medical economic burden before and after the implementation of abolition of drug mark-up policy,and organizing the relevant policy documents to understand the implementation status of abolition of drug mark-up policy.Excel 2019 software was used to establish the database,SPSS 25.0 and R Studio 1.1.456 software were used for statistical analysis and mapping.Descriptive analysis and difference test were performed on the patient’s demographic characteristics,medical information and hospitalization expenses.Gray correlation analysis and structural variation analysis were conducted to analyze the internal composition changes of total average hospitalization expenses for patients with major chronic diseases before and after the implementation of abolition of drug markup policy.The Interrupted times series（ITS）model was used to analyze the level and trend changes of total average hospitalization expenses per time,single expenses and medical insurance expenses for patients with major chronic diseases before and after the implementation of abolition of drug mark-up policy.Results（1）Before and after the implementation of abolition of drug mark-up policy,the top one in the correlation degree of total average hospitalization expenses per time for stroke,COPD,T2 DM and tuberculosis patients was the average western medicine expenses per time,while the average expenses of operation and anesthesia expenses per time were lower in the order of correlation.After the implementation of the policy,the expenses structure of patients with four chronic diseases has changed,and the average expenses of western medicine per time showed negative changes,while the average expenses of examination,anesthesia,treatment,laboratory,surgery and other expenses per time showed positive changes.Except for T2 DM inpatients,the average expenses of traditional Chinese medicine for stroke,COPD and tuberculosis inpatients showed negative changes,while the average material expenses showed positive changes.（2）After the implementation of abolition of drug mark-up policy,the total average hospitalization expenses per time of stroke,COPD,T2 DM and tuberculosis patients decreased by 1275.27 yuan/case,2407.41 yuan/case,2962.50yuan/case and 1085.35 yuan/case,respectively.After the implementation of the policy,the total average hospitalization expenses per time and the average western medicine expenses per time of stroke,COPD,T2 DM and tuberculosis patients showed a monthly decreasing trend.（3）After the implementation of abolition of drug mark-up policy,the average examination expenses per time,average laboratory expenses per time,average material expenses per time,and average other expenses per time for inpatients with stroke were rising in varying degrees.The average examination expenses per time and average other expenses per time for inpatients with COPD,T2 DM were rising in varying degrees.The overall level of other expenses of hospitalized patients with tuberculosis increased.After the implementation of the policy,the average examination expenses kept on monthly upward trends,and the average other expenses per time of stroke inpatients changed from the monthly upward trend to monthly downward trend.When the policy was implemented,the average laboratory expenses per time for inpatients with T2 DM fell immediately.After the implementation of the policy,the average other expenses per time for inpatients with COPD,T2 DM changed from the monthly upward trend before the implementation of the policy to a monthly downward trend,and the average laboratory expenses per time of T2 DM inpatients showed a monthly upward trend after the implementation of the policy,while the average material expenses per time showed a monthly downward trend.When the policy was implemented,the average material expenses per time for tuberculosis inpatients rose immediately,while the average examination expenses per time and the average material expenses per time showed a monthly downward trend after the policy was implemented.（4）After the implementation of abolition of drug mark-up policy,the overall expenses of treatment per time for stroke,COPD,T2 DM and tuberculosis patients increased to varying degrees.When the policy was implemented,the average anesthesia expenses per time and the average operation expenses per time for inpatients with stroke rose immediately.After the implementation of the policy,the average treatment expenses per time and the average operation expenses per time changed from the monthly upward trend to monthly downward trend,and the average anesthesia expenses per time showed a monthly upward trend.After the implementation of the policy,the average treatment expenses per time for inpatients with COPD changed from the monthly upward trend to monthly downward trend.After the implementation of the policy,the average treatment expenses per time for patients with T2 DM changed from the monthly upward trend to the monthly downward trend,while the average anesthesia expenses per time changed from the monthly downward trend to the monthly upward trend,and the average operation expenses per time showed a monthly downward trend.When the policy was implemented,the average anesthesia expenses per time for tuberculosis inpatients rose immediately,while the average operation expenses per time and the average anesthesia expenses per time showed a monthly downward trend after the policy was implemented.（5）After the implementation of abolition of drug mark-up policy,the overall expenses level of traditional Chinese medicine per time for inpatients with stroke and COPD decreased slightly,while the overall expenses level of traditional Chinese medicine per time for inpatients with tuberculosis increased,but the overall expenses level was low and the change range was small.The average traditional Chinese medicine expenses per time for stroke,COPD and tuberculosis inpatients changed from the monthly upward trend to monthly downward trend before the implementation of the policy,among which,the average traditional Chinese medicine expenses per time for tuberculosis inpatients fell immediately when the policy was implemented.（6）After the implementation of the policy,the proportion of total payment per time for stroke,COPD,T2 DM and tuberculosis inpatients increased,while the proportion of individual payment per time decreased.Except tuberculosis,before and after the implementation of the policy,the proportion of stroke,COPD,T2 DM inpatients were higher than the proportion of individual payment,and the reimbursement proportion was more than 50%.After the implementation of abolition of drug mark-up policy,the average individual payment per time for stroke,COPD,T2 DM and tuberculosis inpatients decreased significantly,and the average insurance fund payment per time of COPD and T2 DM inpatients decreased.When the policy was implemented,the proportion of individual payment per time for inpatients with stroke rose immediately.After the implementation of the policy,the average insurance fund payment per time and average individual payment per time for stroke,COPD and tuberculosis inpatients showed a monthly downward trend.The average individual payment per time for T2 DM inpatients showed a monthly downward trend.The proportion of average insurance fund payment per time for stroke and T2 DM inpatients showed a monthly upward trend,while the proportion of average individual payment per time showed a monthly downward trend after the implementation of the policy,consistent with the overall trend of change.Conclusions（1）After the implementation of abolition of drug mark-up policy,the total average hospitalization expenses per time and average western medicine expenses per time showed a monthly decreasing trend.Although the proportion of average western medicine expenses per time decreased,the proportion of average western medicine expenses per time was the highest before and after the implementation of the policy,and it was still the most important factor affecting the total average hospitalization expenses per time for patients with chronic diseases,and the disease economic burden of patients was still heavy.（2）After the implementation of abolition of drug mark-up policy,the proportion of average consumables per time and examination expenses per time increased,and the degree of influence on the total average hospitalization expenses per time of patients with chronic diseases increased.In addition,the expenses of average consumables and examinations per time for patients with chronic diseases increased immediately when the policy was implemented,but decreased monthly in the long term.（3）The level of service charges for inpatients with chronic diseases remained low.in the long term,and the service charges showed a downward trend with small variation after the implementation of the policy.In addition to the average treatment expenses,the average operation,anesthesia expenses per time and other service charges failed to fully reflect the medical personnel of technology and labor value.（4）The actual clinical utility ratio of traditional Chinese medicine in the treatment of chronic diseases was low.The average traditional Chinese medicine expenses per time showed a monthly downward trend,which accounted for a low proportion in the total average hospitalization expenses per time,and had a small impact on the total average hospitalization expenses per time for patients with chronic diseases,and failed to give full play to the characteristic advantages and functions of traditional Chinese medicine in chronic disease prevention,diagnosis,treatment,rehabilitation and health care.（5）After the implementation of abolition of drug mark-up policy,the average insurance fund payment per time,individual payment per time and the proportion of individual payment per time for inpatients with chronic diseases showed a monthly decreasing trend,which achieved the purpose of continuously enhancing the ability of medical insurance reimbursement and risk resistance,reducing the individual payment burden of patients with chronic diseases.