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首页> 外文期刊>Health policy and planning >The impact of China's retail drug price control policy on hospital expenditures: a case study in two Shandong hospitals.
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The impact of China's retail drug price control policy on hospital expenditures: a case study in two Shandong hospitals.

机译：中国药品零售价格管制政策对医院支出的影响：以山东两家医院为例。

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In China, 44.4% of total health expenditures in 2001 were for pharmaceuticals. Containment of pharmaceutical expenditures is a top priority for policy intervention. Control of drug retail prices was adopted by the Chinese government for this purpose. This study aims to examine the impact of this policy on the containment of hospital drug expenditures, and to analyze contributing factors. This is a retrospective pre/post-reform case study in two public hospitals. Financial records were reviewed to analyze changes in drug expenditures for all patients. A tracer condition, cerebral infarction, was selected for in-depth examination of changes in prices, utilization, expenditures and rationality of drugs. In the two hospitals, a total of 104 and 109 cerebral infarction cases, hospitalized respectively before and after the reform, were selected. Prescribed daily dose (PDD) was used for measuring drug utilization, and the contribution of price and utilization to changes in drug expenditures were decomposed. Rationality of drug use post-reform was reviewed based on published literature. Drug expenditures for all patients still increased rapidly in the two hospitals after implementation of the pricing policy. In the provincial hospital, drug expenditures per patient for cerebral infarction cases declined, but not significantly. This was mainly attributable to reduced utilization. In the municipal hospital, drug expenditure per patient increased by 50.1% after the reform, mainly due to greater drug utilization. Three to five fold higher drug expenditure per inpatient day in the provincial hospital was due to use of more expensive drugs. Of the top 15 drugs for treating cerebral infarction cases after the reform, 19.5% and 46.5% of the expenditures, in the provincial and municipal hospitals, respectively, were spent on drugs with prices set by the government. A large proportion of expenditures for the top 15 drugs, at least 65% and 41% in the provincial and municipal hospitals, respectively, was spent on allopathic drugs without an adequate evidence base of safety and efficacy supporting use for cerebral infarction. Control of retail prices, implemented in isolation, was not effective in containing hospital drug expenditures in these two Chinese hospitals. Utilization, more than price, determined drug expenditures. Improvement of rational use of drugs and correcting the present incentive structure for hospitals and drug prescribers may be important additional strategies for achieving containment of drug expenditures.
机译：在中国，2001年卫生总支出中有44.4％用于药品。控制药品支出是政策干预的重中之重。为此，中国政府采取了控制药品零售价格的措施。这项研究旨在检查该政策对控制医院药品支出的影响，并分析影响因素。这是两家公立医院改革前/改革后的案例研究。审查财务记录以分析所有患者的药物支出变化。选择了一种示踪剂，即脑梗塞，以深入检查药物价格，利用率，支出和合理性的变化。在两家医院中，总共选择了分别在改革前后住院的104例和109例脑梗死病例。使用规定的每日剂量（PDD）来衡量药物利用情况，并分解价格和利用情况对药物支出变化的贡献。改革后的药物使用的合理性根据公开的文献进行了回顾。实施定价政策后，两家医院的所有患者的药品支出仍然迅速增加。在省级医院，脑梗死病人的人均药品支出有所下降，但没有明显下降。这主要是由于利用率降低。改革后，市级医院的人均药品支出增加了50.1％，这主要是由于药物使用增加了。由于使用更昂贵的药物，省医院每住院一天的药物支出增加了三到五倍。改革后的前15种用于治疗脑梗死的药物中，省级和市级医院的支出分别占政府规定价格的19.5％和46.5％。前15种药物的大部分支出（分别在省级和市级医院中分别占65％和41％）用于同种疗法药物，但没有足够的证据证明安全性和有效性可支持用于脑梗死。孤立地实施零售价格控制，并不能有效地控制这两家中国医院的医院药品支出。利用率，而不是价格，决定了药品支出。改善合理用药和纠正医院和开药者目前的激励机制，可能是实现遏制药品支出的重要附加战略。

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