The Impact of China's National Essential Medicine Policy and Its Implications for Urban Outpatients: A Multivariate Difference-in-Differences Study
The Impact of China's National Essential Medicine Policy and Its Implications for Urban Outpatients: A Multivariate Difference-in-Differences Study
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DOI：
10.1016/j.jval.2016.10.018
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发表时间：
2017-03-01
期刊：
影响因子：
4.5
通讯作者：
Wu, Jing
中科院分区：
文献类型：
--
作者：
Ding, Liman;Wu, Jing
目的：评价国家基本药物政策（NEMP）对天津市门诊服务利用和费用的影响。研究方法：天津市城镇职工基本医疗保险范围内的所有公立综合性初级卫生保健中心均被纳入研究。其中，49个初级保健中心在2009年4月实施了国家环境管理计划，构成干预组，其余初级保健中心构成对照组。在NEMP前（2008年4月至2009年3月）和NEMP后（2009年4月至2010年3月）至少访问过两组中的一组的患者被纳入相应组。差异-无差异（DID）分析用于估计调整患者社会人口学特征和健康状况的影响。使用倾向评分匹配法测试灵敏度。结果：分别确定了干预组和对照组的23，362名和4，148名患者。与对照组相比，干预组的患者年龄较大（63.7岁对58.8岁; P < 0.001），健康状况较差（Quan-Charlson合并症指数为1.0对0.7; P < 0.001）。控制其他混杂因素的DID结果表明，干预组的年门诊次数、年总费用、药品费用和人均自付费用与对照组无显著差异。倾向评分匹配调整的DID回归模型表现出类似的结果。结论：中国NEMP的实施在短期内对年门诊量、总费用、药品费用和自付费用没有影响，没有达到最初的政策目标。
Objectives: To evaluate the effects of the National Essential Medicine Policy (NEMP) on outpatient service utilization and expenditure in Tianjin, China. Methods: All government-owned general primary health care centers (PHCs) within the Urban Employee Basic Medical Insurance in Tianjin were involved in the study. Of these, 49 PHCs implemented the NEMP in April 2009, and constituted the intervention group, and the remaining PHCs constituted the control group. Patients who had visited only one of the two groups at least once preNEMP (April 2008 to March 2009) and post-NEMP (April 2009 to March 2010) were included in the correspondent group. A difference-indifferences (DID) analysis was used to estimate the impacts adjusting for patients' sociodemographic characteristics and health status. Sensitivity was tested using the propensity score matching method. Results: A total of 23,362 and 4,148 patients from the intervention and control groups were identified, respectively. The patients in the intervention group were older (63.7 years vs. 58.8 years; P < 0.001) and in worse health status, as indicated by the Quan-Charlson comorbidity index (1.0 vs. 0.7; P < 0.001), than their counterparts in the control group. The DID results controlling for other confounders indicated that the annual outpatient visits, total annual expenditure, drug expenditure, and out-of-pocket expenditure per capita for the intervention group were not significantly different from those of the control group. Propensity score matching-adjusted DID regression models demonstrated similar results. Conclusions: The China NEMP implementation did not affect the annual outpatient visits, total expenditure, drug expenditure, and out-of-pocket expenditure in the short term and the original policy goals were not met.