Intended And Unintended Consequences Of China’s Zero Markup Drug Policy

China's Health Reform Update

“…In the same study, average physician service charges and therapeutic service charges increased by 137 RMB and 550 RMB ($21.00 and $85.27), respectively (93). This pattern of decreasing fiscal dependence on drug revenue and increasing dependence on other services and government subsidies is also found in other provinces (75,90) and in national studies of claims data (82). These studies suggest that increases in provider-induced demand for services are an unintended consequence of reform.…”

“…One of the most critical remaining challenges is access: Evidence suggests that EDL policy reduced the availability of essential medicines (82). Using the World Health Organization/Health Action International standardized protocol to study drug availability in pharmacies, longitudinal studies find a significant decrease in drug availability in Shaanxi, especially among EDL drugs (19,31,32).…”

Impact of the zero‐markup drug policy on hospitalisation expenditure in western rural China: an interrupted time series analysis

“…The other reason was that the hospitals increased other fees, which had lower reimbursement proportion or even cannot be reimbursed in the NRCMS. A deep reason may be that the government subsidies were not enough and physicians overprovided medical services or products for patients to get more payment , especially in primary health institutions .…”

Effects of different mark-up drug policies on drug-related expenditures in tertiary public hospitals: an interrupted time series study in Shanghai, China, 2015-2018

“…Physicians in China tend to rely heavily on drug revenue due to the existence of profit margins on drugs (12). They have financial incentives to recommend patients drug therapies even when not appropriate, while patients are generally unable to judge whether the recommended drugs are suitable, which provides a shortcut for physicians to prescribe and profit from unnecessary medications (13,14).…”