The Impact Of Healthcare Reform On Patient Welfare

In order to solve the problems of drug abuse,excessive treatment and other medical irregularities,China issued the “Opinions of the Central Committee of the Communist Party of China and the State Council on Deepening the Reform of the Medical and Health System” in March 2009.This means a new round of medical reform was officially launched.The reform emphasizes the huge role of the government’s public finance in medical and health services.The core measures are to eliminate the markups on medicines in public hospitals and reduce the prices of medicines in the hope of solving the problem of high hospitalization expense.Public hospitals should change the medicine addition compensation into the medical service expense compensation,and increase the medical service expense in different proportion according to the rating of hospitals.Specific to Shanghai,from 2014 to 2018,the relevant government departments issued a number of notification to ensure the progress of medical reform.The policies include establishing efficient operation of the medical security system,establishing an orderly drug supply system and establishing a strict supervision system.The most important policy was the issuance of "notice on issues related to drug markups in public medical institutions in this city" in February 2017,which reduced the drug markups rate in Shanghai public hospitals to 0.Therefore,this article regards this policy as a turning point in Shanghai’s health care reform policy.We use the data of a hospital in Shanghai from January to March 2016 and from October to December 2018 to analyze the policy effect.We take the proportion of patients’ medical expenses and medical costs as the research object.Firstly,we conducted a preliminary analysis of the policy effects of medical reform from three aspects: the composition of hospitalization expenses of patients in different departments,the composition of hospitalization expenses of Shanghai medical insurance patients,and the hospitalization expenses of self-paying patients.Then we used the before-after model to do empirical analysis.We also test the heterogeneity of the policy effect.We analysis the effect of medical insurance on the policy effect and the difference between patients in different wards.The results of this study found that compared with 2016,the medical cost of patients increased by 3.89% in 2018,but the proportion of medical expenses in medical expenses decreased by 6.51% on average.This indicates the reform has effectively reduced the burden on patients’ consumption of medicines and improved patient welfare.At the same time,by examining the heterogeneity of policy effects,we found that for patients with Medicare,medical expenses increased significantly in 2018,and medical expenses did not change significantly for patients who did not use Medicare.Regardless of whether patients has Medicare or not,the policy has effectively reduced their drug cost share.For patients without Medicare,their drug cost share has decreased more.In addition,for wards using more drug,the medical reform has not only significantly reduced the hospitalization costs of patients,but also reduced the proportion of drug costs.In the ward where the drug using is relatively low,the medical reform has increased the hospitalization cost of the patient in the ward,and has no significant effect on the proportion of patients’ drug costs.Based on the research results of this paper,we think that the next phase of medical reform should continuously improve the quality of medical services and establish an effective coordination mechanism.At the same time,it is necessary to establish a scientific operational compensation mechanism to enhance the enthusiasm of medical staff.The research results of this paper have important practical significance for further promoting medical reform and establishing an effective medical security system.