Influence of comprehensive medicine price reform on hospitalization expenses: an analysis with quantile regression model

  Objective   To analyze the influence of comprehensive medicine price reform on amount and structure of hospitalization expenses using quantile regression model for evaluating the effectiveness of the reform and making policy recommendations.

  Methods   Using cluster sampling, we extracted the data on 1 905 coronary disease patients hospitalized during September 2017 – August 2018 and 3 592 hospitalized during September 2016 – August 2017 in a grade A tertiary hospital in Xinjiang Uygur Autonomous Region as the experiment and the control group. Non-parametric test and quantile regression were used to analyze changes in hospitalization expenses and effects of medicine price reform.

  Results   There were significant discrepancies in average hospitalization expenses per hospitalization, out-of-pocket expenses, material expenses, drug expenses and other expenses between the two groups (P < 0.05 for all). The results of quantile regression analysis demonstrated that the time variable exerted a significant effect on all quantile values of expenses of all items (including positive effect on all quantile values of diagnosis, treatment, and nursing expenses and on 0.25 quantile value for other expenses, but negative effect on all quantile values of expenses of all remaining items, P < 0.05 for all) except for 0.75 quantile value for out-of-pocket expenses, 0.25 quantile value for drug expenses and 0.50 quantile value for other expenses (P > 0.05 for all); the type of medical insurance showed a significant effect on all quantile values of expenses of all items (P < 0.05 for all) but no significant effect on the 0.25 quantile values of expenses for drug, diagnosis/treatment, check-up, and other expenses (all P > 0.05); duration of hospitalization had a significant positive effect on all quantile values of expenses for all items (P < 0.05 for all).

  Conclusion   The comprehensive medicine price reform has generally reduced hospitalization expenses of patients but special attention should be paid in the reform to items with high out-of-pocket expenses and homogenized management of insurance institutions.