Empirical Evaluation Of The Zero Markup Drug Policy In Public Medical Institutions

How to control the fast-growing medical expenses has always been the main challenge faced by China's medical reform.Among them,the high cost of medicines is a major problem.In recent years,although the proportion of drug costs in medical expenses has begun to decline,in 2009 the proportion was still as high as 40.3%.This proportion of Western market economy countries generally does not exceed 20%.In most economically developed countries,this proportion rarely exceeds 25%.Even in the East Asian developed countries(Japan and South Korea),which are considered to be drug-oriented,this proportion generally does not exceed 30%.The high cost of medicines not only aggravates the medical burden of patients,but also reflects the existence of overuse or even abuse of medicines to a certain extent,and the pattern of "medicine supplementing medicine" prevailing in medical institutions,indicating the efficiency of the allocation of medical resources in China,there is still much room for improvement.In order to break the disadvantages of "supporting medicine with medicine" and reducing the medical burden on residents,since 2009,China has implemented the zero markup policy(ZMDP)in government-run primary medical institutions,county-level public hospitals,and urban public hospitals.By sorting out the zero markup policy(ZMDP)for different medical institutions,we can find that policy makers are trying to reshape the incentive mechanism of public medical institutions by the zero markup policy(ZMDP).The most critical goal is to control the excessive increase of medical expenses and reduce the burden on patients;at the same time,taking into account the differences in the functional positioning,service objects and service capabilities of different levels of medical institutions,in the process of reform,different supporting measures have been implemented according to local conditions.Therefore,the compensation model for different types of public medical institutions after the zero markup policy(ZMDP),there are big differences.Among them,the primary medical institutions are mainly government compensation,while county-level public hospitals and urban public hospitals are mainly adjusted by medical service prices,supplemented by government financial subsidies.The research includes the following three questions:(1)has the zero markup policy(ZMDP)achieved the expected results? After the drug bonus is cancelled,while the cost of medicines paid by patients declines,will the actual medical burden not be alleviated due to the increase in non-pharmaceutical medical burden,and may even lead to a new round of "induced demand" and "medicine support" ?The emergence of "medicine" affects the realization of the effect of the zero markup policy?(2)Because different types of medical institutions face different environments and constraints,in order to compensate for the decrease in income after the zero markup policy(ZMDP),the government-run primary medical institutions mainly increased revenue by increasing financial subsidies,while county-level and urban public hospitals mainly adopted rational adjustment Medical service price to compensate,is the policy effect obtained by the two compensation modes consistent? For primary medical institutions,will the availability of financial subsidy policies affect the effect of the zero markup policy(ZMDP)? And for county and city public hospitals,is the adjustment of medical service prices sufficient to guarantee the effect of the zero markup policy(ZMDP)?(3)Is the impact of the zero markup policy(ZMDP)on the cost of medicine and the amount of medical services sustainable? In the longer term,will the zero markup policy(ZMDP)have a negative impact on patients' actual medical burden and quality? Because of the differences in service targets,is there a significant heterogeneity in the impact of the zero markup policy(ZMDP)on the actual medical burden and quality of health?In this regard,based on the data of micro-medical data combining medical institutions and patients,this paper systematically evaluates the effect of the zero markup policy(ZMDP)on government-run primary medical institutions,county-level public hospitals,and urban public hospitals by using Difference in Difference,Synthetic Control Method and other measurement methods.The results found that:(1)After the zero markup policy(ZMDP)was used,the drug costs of all public medical institutions decreased significantly,and the cost of outpatients and hospitalizations decreased in the short term,and the long-term changes were not obvious;(2)For the government-run primary medical institutions,the drug costs decreased.At the same time,the cost of non-drugs has also decreased,and the cost of outpatients and hospitalizations has decreased significantly in the short term,but the long-term changes in hospitalization costs are not obvious.For county-level public hospitals,the cost of non-drugs,including inspection costs,has decreased significantly Increased,outpatient and inpatient costs have decreased significantly in the short and long term;for urban public hospitals,drug costs have decreased significantly while non-drug costs have increased significantly,but inspection costs have not changed significantly,as a result,outpatient costs have not changed significantly,and inpatient costs Significant decline in the short term,but no significant change in the long term.At county and city public hospitals,the compensation model for adjusting medical service prices has increased non-pharmaceutical costs,and even inspection costs,while government-run primary medical institutions have adopted increased financial subsidies.At this time,non-drug costs have not increased,but have fallen;(3)For inpatients,it was found that the zero markup policy(ZMDP)significantly improved the quality of medical treatment,but the impact on medical burden differed depending on the disease.Based on the above conclusions,this article finds that the effect of controlling excessive increases in medical costs by the zero markup policy(ZMDP)is limited.Therefore,policy makers should focus on implementing government financial subsidies,consider carrying out comprehensive medical service reforms including reform of medical insurance payment methods,form a joint effort to control costs,and based on the actual conditions of medical institutions,deepen and promote reforms and other corresponding supporting measures to control medical expenditure.