Analysis of structural variations and effects of the national volume-based procurement policy on inpatient costs: a real world study of osteoporotic hip fractures in Shanghai, China

Jing Yan¹Qiujun Qin¹Xinye Fang¹Fen Li^2*Bifan Zhu^1*

• ¹Shanghai Health Development Research Center, Shanghai, China
• ²Shanghai Municipal Health Commission, Shanghai, China

Background: As one of the most severe clinical manifestations of osteoporosis, osteoporotic hip fractures often require surgical treatment and result in high medical costs. The hospitalization expenses for patients with osteoporotic hip fractures in China have been on the rise. This research aims to analyze the structure of hospitalization costs and their changes over an extended period in Shanghai, China, and to investigate the impact of the national volume-based procurement (NVBP) policy on costs associated with osteoporotic hip fractures. Methods:Data were obtained from the Shanghai Health Statistics Center, which includes hospitalization records for patients at all medical institutions in Shanghai from January 2017 to December 2022. Structural variation analysis and new gray correlation analysis were employed to explore the shifts and degree of association in yearly hospitalization cost composition. Additionally, we evaluated the effects of the NVBP using interrupted time series analysis. Results: While there was a decline in 2022, medical consumable expenses accounted for over 59% of total inpatient costs for osteoporotic hip fractures and consistently demonstrated the highest correlation with total hospitalization costs in Shanghai from 2017 to 2021. Drug costs not only had the highest contribution rate to overall inpatient expenses during the years 2017-2018 (44.22%) and 2020-2021 (36.76%) but also held the top position in the contribution rate of structural variation (CRSV) from 2017 to 2022 (45.77%). The stratification results indicated that medical consumable costs for tertiary and secondary hospitals decreased in 2021-2022, with CRSVs of 23.36% and 37.91%. After the NVBP policy was implemented, total hospitalization costs significantly decreased by 5,022.088 yuan (P < 0.001). Additionally, hospitalization costs exhibited a significant downward trend over time, decreasing by 596.114 yuan after the intervention (P < 0.001). Medical consumable costs also exhibited a declining pattern regarding both immediate effects and long-term patterns after the reform, with an average decrease of 290.448 yuan (P < 0.001). Conclusions:The costs of medical consumables related to osteoporotic hip fractures declined due to the implementation of the NVBP. Future policy should focus on addressing the rising hospitalization costs of osteoporotic hip fractures, particularly those associated with medical consumables and drugs.