Research On The Impact Of Medical Consumables Zero-markup Policy On Patients’ Medical Expenses

Since China introduced the drug price zero-markup policy in 1954,the drug markup income has become legal,and the drug income gradually became the main source of hospital funding.In 2009,the Opinions of the State Council of the CPC Central Committee on Deepening the Reform of the Medical and Health Care System clearly stated for the first time that the drug price zero-markup policy would be gradually implemented in public medical institutions.As of September 2017,the policy had been fully implemented in urban public medical institutions nationwide,marking the end of the drug price markup policy that had lasted for more than 60 years.After the persistent problem of drug-maintaining-medicine in public medical institutions was solved,the proportion of consumables in patients’ medical costs gradually increased,which increased the medical burden of patients and shifted drug-maintaining-medicine into consumables-maintaining-medicine.N Municipal Development and Reform Commission,Human Resources and Social Security Bureau,and Health and Family Planning Commission jointly issued a document,making it clear that all public medical institutions managed by the municipal government of N City have implemented the zero-markup policy on medical consumables since December 2018,and the price of medical services for simultaneous adjustment.This paper quantitatively investigates the impact of the zero-markup policy on medical consumables on patients’ outpatient and inpatient medical costs in public medical institutions adopting the degree of structural variation analysis and gray correlation model based on annual statistics of medical and health institutions surveyed by the Municipal Health Commission from 2015 to 2019.The main findings are as follows: 1.The effect of the zero-markup policy on medical consumables is significant,and the burden of patients’ medical costs is relieved.2.The price adjustment of medical services is unreasonable,and the structure of medical costs needs to be further optimized.90% of the reduction in revenue caused by the zero-markup policy on medical consumables in public medical institutions in N can be offset by adjusting the price of medical services.According to the research,the adjustment of the price of medical services mainly increases the items of hospitalization expenses that reflect the labor value of highly skilled medical personnel,while ignoring the adjustment of the items that reflect the labor value of general medical personnel,and the structure of medical costs for patients still needs to be further optimized.3.After the implementation of the medical consumables zero-markup policy,the problem of inspection-maintaining-medicine has come to the fore.The value of the structural variation of inspection fees in both outpatient and inpatient costs was positive from 2015 to 2019,and it is clear that inspectionmaintaining-medicine has become another point to drive profits for public medical institutions after drugs and medical consumables.Based on the research results,this paper puts forward three recommendations:1.Optimize the dynamic adjustment mechanism of medical service price.Public medical institutions in China is self-financing non-profit institutions,therefore,it is necessary to establish a dynamic adjustment mechanism for the price of medical services that conforms to the law of value of the public medical institutions industry.2.Strengthen the sophisticated management of medical consumables.The medical consumables zero-markup policy has transformed medical consumables from income-generating carriers into cost expenditures,forcing the management of medical consumables in public medical institutions to be sophisticated.3.Deepen the reform of medical and health care system,to prevent the inspection-maintainingmedicine.Therefore,it is important to accelerate the implementation of the clinical laboratory results inter-accreditation policy,and scientifically set the upper limit of inspection expenses and laboratory expenses in the total medical expenses.The main innovations of this paper are: 1.Data innovation.Most of the existing domestic studies are based on the medical cost data of one hospital or the relevant data collected through questionnaire surveys,which are relatively lacking in accuracy and completeness.The data in this paper comes from the annual statements of medical and health institutions surveyed by the Municipal Health Commission,including information on all medical and health institutions and township hospitals in N City,with basic information on medical and health institutions,medical service provision,resource allocation,and financial situation(total income of medical and health institutions,outpatient income,inpatient income,the total expenditure of medical and health institutions,etc.).2.Methodological innovation.The current research on the zero-markup policy of medical consumables is mainly qualitative research,and quantitative research is relatively insufficient.This paper adopts the degree of structural variation analysis and gray correlation model to conduct quantitative research,so as to study the total medical expenses of outpatients and inpatients and the structural variation before and after the implementation of the zero-markup policy of medical consumables in a more comprehensive and accurate way.