AUTHOR=Guo Xirui , Xiao Yao , Liu Huan , Li Qinchuan , Jiang Qian , Liu Chun , Xie Fangqing , Wang Hongju , Yang Fang , Han Xiao , Yang Hengbo , Yang Yong , Ye Yongqin , Gan XiaoHong , Long Enwu 

TITLE=Impacts of the zero mark-up policy on hospitalization expenses of T2DM and cholecystolithiasis inpatients in SC province, western China: an interrupted time series analysis

JOURNAL=Frontiers in Public Health

VOLUME=Volume 11 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2023.1079655

DOI=10.3389/fpubh.2023.1079655

ISSN=2296-2565

ABSTRACT=Background: Since 2009, a series of ambitious health system reforms has been launched in China, including the zero mark-up drug policy (ZMDP), the policy was intended to reduce substantial medicine expenses for patients by abolishing the 15% markup on drugs. This study aims to evaluate the impacts of ZMDP on medical expenditures from the perspective of disease burden disparities in western China.
Method: Two typical diseases including Type 2 diabetes mellitus (T2DM) in internal medicine and cholecystolithiasis (CS) in surgery were selected from medical record in a large tertiary level-A hospital in SC Province. The monthly average medical expenses of patients from May 2015 to August 2018 were extracted to construct an interrupted time series (ITS) model to evaluate the impact of policy implementation on financial burden. 
Results: A total of 5,764 cases were enrolled in our study. The medicine expenses for T2DM patients maintained a negative trend both before and after the intervention of ZMDP. It had declined by 74.3 CNY (P < 0.001) per month on average in the pre-policy period, and subsequently dropped 704.4 CNY (P =0.028) immediately after the policy. The level change of hospitalization expenses was insignificant (P =0.197), with a reduction of 677.7 CNY after the policy, while the post-policy long-term trend was significantly increasing by 97.7 CNY (P =0.035) per month contrasted with the pre-policy period. Besides, the anesthesia expenses of T2DM patients had a significant increase in level under the impact of the policy.  In comparison, the medicine expenses of CS patients significantly decreased by 1014.2 CNY (P < 0.001) after the policy, while the total hospitalization expenses had no significant change in level and slope under the influence of ZMDP. Furthermore, the expenses of surgery and anesthesia for CS patients significantly increased by 320.9 CNY and 331.4 CNY immediately after the policy intervention.
Conclusion: Our study indicated that the ZMDP has been an effective intervention to reduce the excessive medicine expenses for both researched medical and surgical diseases, but failed to show any long-term advantage. And the policy has no significant impact on reliving the overall hospitalization burden for either condition.