中国实施药品零差率政策,扭转公共卫生机构过度用药的局面,通过改变扭曲的融资机制,这在很大程度上依赖于药品产生的收入。2015年至2017年,城市公立医院逐步实施药品零差率政策。
这项研究预计将通过主观测量产生令人信服的证据,并有助于从客观和主观角度对政策进行更全面的评估。
本研究基于具有准实验设计的大型患者水平数据集。我们采用了差异(DID)方法,结合倾向得分匹配方法,从患者的角度估计该政策在减少过度处方方面的因果效应。
该研究估计,有统计学意义的增加的可能性,即接受治疗的门诊患者在他们的就诊医院否认过度处方。互动的平均政策效应,以百分点计,所有观察结果均为阳性(logitDID模型:0.15,z=10.27,SE=0.01;PSMlogitDID模型:0.15,z=10.26,SE=0.01;PSMlogitDID医院固定效应模型:0.12,z=3.00,SE=0.04).
从患者的角度来看,该政策可能会减少公立医院的过度处方。患者的态度是全面政策评估的一个方面。政策评估的最终具体结论只能通过对具有严格设计和客观和主观测量的研究进行系统审查来得出。
China implemented the zero-markup medicines policy to reverse the overuse of medicine in public health institutions, by changing the distorted financing mechanism, which heavily relies on revenue generated from medicines. The zero-markup medicines policy was progressively implemented in city public hospitals from 2015 to 2017.
This study is expected to generate convincing evidence with subjective measurements and contribute to a more comprehensive evaluation of the policy from both objective and subjective perspectives.
This study was based on a large patient-level dataset with a quasi-experimental design. We employed the difference-in-difference (DID) method, combined with propensity score matching methods, to estimate the causal effect of the policy in reducing overprescriptions from the patient perspective.
The study estimated a statistically significant increased probability that the responded outpatients denied overprescription in their visiting hospitals. The mean interacted policy effect, in percentage points, of all observations were positive (logit DID model: 0.15, z = 10.27, SE = 0.01; PSM logit DID model: 0.15, z = 10.26, SE = 0.01; PSM logit DID hospital fixed-effect model: 0.12, z = 3.00, SE = 0.04).
The policy might reduce overprescription in public hospitals from the patient\'s perspective. The patient\'s attitude is one aspect of a comprehensive policy evaluation. The final concrete conclusion of the policy evaluation can only be made through a systematic review of the studies with rigorous design and with both objective and subjective measurements.