Impact of the National Centralized Drug Procurement Policy (4 + 7 policy) on the drug expenditures of patients treated in outpatient and emergency departments in a large tertiary level‐A hospital in China: A single centre, interrupted time series

Abstract

Summary What is known and objective Like many countries in the world, China is also facing growing drug expenditures year by year. In particular, the rising cost of prescription drugs has been one of the critical factors leading to the serious burden on health insurance programs. The high cost of prescription drugs not only threatens the health budget but also limits the nation's investment in other public sectors. China implemented the National Centralized Drug Procurement (NCDP) policy, also known as the "4 + 7" policy, in tertiary hospitals in various provinces and cities across the country on 18 December 2019, aiming to lessen personal and national health insurance burdens by reducing drug procurement prices. The aim of this study is to explore the impact of the implementation of the NCDP policy on the drug expenditures of patients treated in outpatient and emergency departments and on national health insurance expenditures. Methods This study adopts interrupted time series (ITS) to evaluate the impact of China's implementation of the NCDP policy on the drug expenditures of patients treated in outpatient and emergency departments in a tertiary hospital. The NCDP policy was officially implemented on 18 December 2019. A segmented regression model is utilized to analyse the average monthly drug expenditures of patients treated in outpatient and emergency departments from January 2018 to June 2021, including the average monthly per‐visit drug expenditures of all patients and the average monthly per‐visit drug expenditures of patients who paid for drugs with health insurance and those who did not use health insurance. Results After the implementation of the NCDP policy, the overall average monthly per‐visit drug expenditures of patients treated in outpatient and emergency departments were immediately reduced by 233.954 CNY (p < 0.01). Compared with the continued downward trend for drug expenditures before the implementation of the NCDP policy, the long‐term trend after policy implementation was not obvious (p = 0.051973>0.05). Similarly, the average monthly per‐visit drug expenditures of patients treated in outpatient and emergency departments who use health insurance to procure drugs also immediately decreased by 505.287 CNY (p < 0.01), but the long‐term trends before (p = 0.469>0.05) and after policy implementation (p = 0.51>0.05) did not exhibit obvious change. For the average monthly per‐visit drug expenditures of patients treated in outpatient and emergency departments who did not use health insurance, the implementation of the NCDP policy did not produce an immediate reduction in drug expenditures (p = 0.3603>0.05). Although the average monthly per‐visit drug expenditures decreased by 9.078 CNY (p < 0.01) before policy implementation, this trend ended after the policy was implemented (p = 0.0735>0.05), and no other changes were triggered. What is new and conclusion This study reviews the data for a period of time before and after the implementation of the NCDP policy. The policy is shown to significantly dec...

The impact of national centralized drug procurement on health expenditures for lung cancer inpatients: A difference-in-differences analysis in a large tertiary hospital in China

“…Our study showed that after the implementation of NCDP, the total expenditures and drug expenditures of hospitalization for lung cancer patients decreased by 14.13 and 20.75%, respectively. This result was consistent with previous studies and it was reasonable because the NCDP policy was expected to reduce pharmaceutical spending and improve the accessibility of medical services (21)(22)(23). The prices of the 25 winning drugs in the first round of NCDP dropped by an average of 52% with the highest drop of 96% (5).…”

“…Although there is strong consistency between drug purchase data and drug use data (such as prescriptions and claims), it is possible that the policy effects on patients could not be evaluated through procurement records (21,22). Only one study used the hospital information system data, but this study applied an interrupted time series design and estimated the average monthly drug expenditures of patients treated in outpatient and emergency departments (23).…”

Effects of volume-based procurement policy on the usage and expenditure of first-generation targeted drugs for non-small cell lung cancer with EGFR mutation in China: an interrupted time series study

“…There were few reports in China on the policy of centralised drug procurement, and the reported literature payed more attention to the price changes 18–21. In addition, the effect of the new volume-based centralised drug procurement policy (NVBP policy) on the usage and expenditure of related drugs was less reported 22–30…”

Has the Volume-Based Drug Purchasing Approach Achieved Equilibrium among Various Stakeholders? Evidence from China

“…Among these, centralized drug procurement, as a governance tool aimed at controlling costs and guaranteeing the quality of drugs, was mentioned for the first time at national policy level [ 6 ]. The coverage focuses on drugs with high usage and procurement within the basic health insurance drug catalogue [ 7 ]. This policy aims to obtain preferential drug prices by integrating national market purchases, and is termed national centralized drug volume-based procurement (VBP).…”