The Effects of County Public Hospital Reform on the Consumption and Costs of Antibiotics: Evidence from a Quasinatural Experiment in Jiangsu, China.
The Effects of County Public Hospital Reform on the Consumption and Costs of Antibiotics: Evidence from a Quasinatural Experiment in Jiangsu, China.
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县公立医院改革对抗生素消费和成本的影响：来自中国江苏省准自然实验的证据
DOI：
10.1155/2020/9262170
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发表时间：
2020
影响因子：
--
通讯作者：
Li X
中科院分区：
文献类型：
--
作者：
Wang Y;Zhu Y;Liu X;Xu X;Fang W;Li X
抗生素的过度使用是全球范围内抗生素耐药性快速传播的主要驱动力，在中国尤其常见。医院收入与药品销售之间的密切联系已成为抗生素过度处方的关键诱因。自2009年以来，中国政府实施了一系列措施来切断这种联系，包括取消药品加价，增加财政补贴，调整医疗服务收费。目的评价江苏省县级公立医院改革对采购抗生素使用量及费用的影响。方法采用准实验设计，在江苏省先后实施改革的99所县级公立医院中，对不同时期的改革方案进行比较分析。其中37家县级公立医院自2013年1月起实施改革，作为干预组，其余62家医院纳入对照组。对2012年1月至2013年12月的抗生素采购记录进行了广义线性回归的差异分析（DID）。家系分布采用改良Park检验，对数链采用Box-Cox检验。采用安慰剂检验来检验两组的共同趋势假设。结果干预组限用抗生素和注射用抗生素平均采购量分别增加24.12%和2.75%，费用分别增加19.01%和9.09%。限制性和注射性抗生素的每DDD平均成本远高于非限制性和口服抗生素。DID结果显示，改革对非限制性抗生素的平均数量（p = 0.005）和成本（p = 0.001）产生了积极影响。此外，改革的实施与口服抗生素采购量（p = 0.031）和成本（p = 0.043）的减少有关。改革还导致总抗生素每DDD的平均成本增加（p = 0.049）。结论改革有效降低了非限制性和口服抗生素的用量和费用，但未能降低昂贵的限制性和注射性抗生素的用量和费用，导致疾病负担增加。至关重要的是，卫生政策举措可以在医院和医生个人层面上抑制抗生素的过度使用。改革应加大政府财政支持力度，完善医院治理，优化绩效考核，建立抗生素使用专业化管理办法。
Background Overuse of antibiotics is a major driver for rapid spread of antimicrobial resistance worldwide, particularly common in China. The close linkage between hospital revenue and sales of drugs has become the key incentive for overprescription of antibiotics. Since 2009, the Chinese government implemented a series of measures to cut off the link, including removing the markup of drugs, increasing financial subsidies, and adjusting charges for medical service. Objective To evaluate the impacts of county public hospital reform on the consumption and costs of procured antibiotics in Jiangsu province. Methods A quasiexperiment design was conducted in Jiangsu province where 99 county public hospitals implemented the reform successively in different periods. Of these, 37 county public hospitals implemented the reform since January 2013, which were regarded as the intervention group, and the remaining 62 hospitals were included in the control group. A difference-in-differences (DID) analysis with generalized linear regressions was used on the procurement records of antibiotics from January 2012 to December 2013. Modified Park test was used for family distribution and Box–Cox test for log link. Placebo tests were employed to test the common-trend hypothesis of two groups. Results For the intervention group, the average volume of procured restricted antibiotics and injectable antibiotics increased by 24.12% and 2.75% while the costs increased by 19.01% and 9.09%, respectively. The average costs per DDD of restricted and injectable antibiotics were much higher than unrestricted and oral antibiotics. The DID results showed that the reform had a positive impact on the average volume (p = 0.005) and costs (p = 0.001) of nonrestricted antibiotics. In addition, the implementation of the reform was associated with a reduction in volume (p = 0.031) and costs (p = 0.043) of procured oral antibiotics. The reform also contributed to an increase in average costs per DDD of total antibiotics (p = 0.049). Conclusions The reform is effective in reducing the consumption and costs of unrestricted and oral antibiotics, but it has failed to reduce the consumption and costs of expensive restricted and injectable antibiotics, leading to increased burden of diseases. It is critical that the health policy initiatives can deincentivize overuse of antibiotics at both hospital and individual physician's levels. The reform should enforce government financial support, improve hospital governance, optimize performance evaluation, and establish specialized management approach for antibiotic use.
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影响因子：
3.7
作者：
Ding L;Sun Q;Sun W;Du Y;Li Y;Bian X;He G;Bai H;Dyar OJ
通讯作者：
Dyar OJ
影响因子：
5.2
作者：
Lin, Hai;Dyar, Oliver James;Lundborg, Cecilia Stalsby
通讯作者：
Lundborg, Cecilia Stalsby
影响因子：
5
作者：
Currie J;Lin W;Meng J
通讯作者：
Meng J
影响因子：
4.5
作者：
Ding, Liman;Wu, Jing
通讯作者：
Wu, Jing
影响因子：
56.3
作者：
Laxminarayan, Ramanan;Duse, Adriano;Cars, Otto
通讯作者：
Cars, Otto