OBJECTIVES

: In 2009, China launched a new round of healthcare reform in public hospitals to control the accelerated growth of healthcare expense. The main component of this reform is zero markup drug policy (ZMDP), which was implemented in three levels of public hospital: primary community healthcare centres (PCHCs), county level and city level. This study aims to review the impact of ZMDP on drug price and drug expense.

METHODS

A literature research was conducted in both English (PubMed) and Chinese database (CNKI) using keywords related to “medical reform”, “China” and “price”. Government websites and grey literatures were manually screened. Studies comparing the drug prices and drug expenses before and after the reform were included. Location and timing of implementing the reform, drug prices of overall drugs, traditional Chinese medicines and western medicines and drug expenses before and after the reform were extracted. Descriptive analysis was conducted among within each level of public hospital.

RESULTS

: In total, 5 studies were identified after screening 134 articles, with 3 studies reporting the impact on drug price and 3 studies on drug expenses. For drug price, a median decrease of 34.40%, 13.04% and 14.04% was reported in PCHCs, county and city levels respectively. Larger decrease in drug price was reported for western medicines compared to traditional Chinese medicine (41.60% vs. 24.30% in PCHCs, 15.26% vs. 12.71% in city level). Drug expenses changes were reported only in country-level public hospital, with a decrease of 6.30% in total healthcare expense. Larger decrease in drug expense was found in outpatient expense rather than in inpatient expense (11.73% vs. 3.90%).

CONCLUSIONS

: ZMDP has higher impact on the drug price in public hospitals in PCHCs levels compared to the city and country levels, and managed to decrease the total healthcare expense by loweringthe drug expense.