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How Did Zero-Markup Medicines Policy Change Prescriptions in the Eyes of Patients?—A Retrospective Quasi-Experimental Analysis

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  • Hanchao Cheng

    (School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, 5 Dongdansantiao, Dongcheng District, Beijing 100730, China)

  • Yuou Zhang

    (School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, 5 Dongdansantiao, Dongcheng District, Beijing 100730, China)

  • Jing Sun

    (School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, 5 Dongdansantiao, Dongcheng District, Beijing 100730, China)

  • Yuanli Liu

    (School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, 5 Dongdansantiao, Dongcheng District, Beijing 100730, China)

Abstract

Background: China implemented the zero-markup medicines policy to reverse the overuse of medicine in public health institutions, by changing the distorted financing mechanism, which heavily relies on revenue generated from medicines. The zero-markup medicines policy was progressively implemented in city public hospitals from 2015 to 2017. Objective: This study is expected to generate convincing evidence with subjective measurements and contribute to a more comprehensive evaluation of the policy from both objective and subjective perspectives. Methods: This study was based on a large patient-level dataset with a quasi-experimental design. We employed the difference-in-difference (DID) method, combined with propensity score matching methods, to estimate the causal effect of the policy in reducing overprescriptions from the patient perspective. Results: The study estimated a statistically significant increased probability that the responded outpatients denied overprescription in their visiting hospitals. The mean interacted policy effect, in percentage points, of all observations were positive (logit DID model: 0.15, z = 10.27, SE = 0.01; PSM logit DID model: 0.15, z = 10.26, SE = 0.01; PSM logit DID hospital fixed-effect model: 0.12, z = 3.00, SE = 0.04). Discussion: The policy might reduce overprescription in public hospitals from the patient’s perspective. The patient’s attitude is one aspect of a comprehensive policy evaluation. The final concrete conclusion of the policy evaluation can only be made through a systematic review of the studies with rigorous design and with both objective and subjective measurements.

Suggested Citation

  • Hanchao Cheng & Yuou Zhang & Jing Sun & Yuanli Liu, 2022. "How Did Zero-Markup Medicines Policy Change Prescriptions in the Eyes of Patients?—A Retrospective Quasi-Experimental Analysis," IJERPH, MDPI, vol. 19(19), pages 1-11, September.
    • Handle: RePEc:gam:jijerp:v:19:y:2022:i:19:p:12226-:d:926141
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    References listed on IDEAS

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    1. Fu, Hongqiao & Li, Ling & Yip, Winnie, 2018. "Intended and unintended impacts of price changes for drugs and medical services: Evidence from China," Social Science & Medicine, Elsevier, vol. 211(C), pages 114-122.
    2. Linlin Hu & Bright P. Zhou & Shiyang Liu & Zijuan Wang & Yuanli Liu, 2019. "Outpatient Satisfaction with Tertiary Hospitals in China: The Role of Sociodemographic Characteristics," IJERPH, MDPI, vol. 16(19), pages 1-13, September.
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    1. Joosse, Iris R. & Tordrup, David & Glanville, Julie & Mantel-Teeuwisse, Aukje K. & van den Ham, Hendrika A., 2023. "A systematic review of policies regulating or removing mark-ups in the pharmaceutical supply and distribution chain," Health Policy, Elsevier, vol. 138(C).

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