Impacts of Long-Term Prescription Policy on Primary Care Utilization and Costs Among Hypertensive Patients in China: A Difference-in-Differences Analysis

OBJECTIVES: To address the long-term drug needs of patients with chronic diseases, China has recently implemented the long-term prescription policy at primary care. This study aims to evaluate the impact of this policy on healthcare utilization and costs at community health centers (CHCs) among hypertensive patients.

METHODS: The study population was hypertensive patients enrolled in chronic disease management in 2014 from a capital city in eastern China. Their demographic characteristics, healthcare utilization and costs from January 2014 to December 2019 were collected from the health insurance claim database. Long-term prescription policy, implemented from 2018, allowed patients who register with family doctors to have up to 12-weeks prescription. We applied a difference-in-differences model to examine policy impact, comparing patients’ healthcare utilization and costs between who were eligible for long-term prescription policy and who were not.

RESULTS: A total of 164,857 hypertensive patients were included with average age as 65.19 years old. The average annual number of outpatient visits at CHCs was 19.82 in 2017, with growth rate of 7.25% from 2014, while decreased to 16.10 in 2019. The median interval of prescriptions at CHCs was 24.50 days in 2017, with decrease rate of 7.59% from 2014, whilst prolonged to 29.72 days in 2019. The average annual outpatient costs were USD 1,004.87 and USD 988.64 in 2017 and 2019, respectively. The long-term prescription policy significantly reduced the annual outpatient visits by 2.44 at CHCs and 0.19 at pharmacies, prolonged the median interval of prescriptions by 3.16 days at CHCs. There was no significant effect on the annual outpatient costs at CHCs, while reduced the average annual drug costs at pharmacies by 48%.

CONCLUSIONS: Long-term prescription policy effectively prolonged the intervals of prescriptions and reduced the number of patient visits for drug refills. Its impact on healthcare costs needs to be further observed.