Impacts Of National Essential Medicine System On Health Care Utilization And Expenditure For Patients In Basic Medical Insurance

National Essential Medicine Policy(NEMP)is one of the most critical measures of medical system reform in China,this system focused on the primary healthcare centers(PHCs),aiming to guide patients to the PHCs for seeking healthcare services,as well as promote the availability and affordability of medicines,then reduce both the total and out-of-pocket(OOP)economic burden on health care recipients.This study was designed to explore the effects on medical service utilization and expenditure after the implementation of the NEMP in Tianjin PHCs.Data were obtained from the administrative claims of the Tianjin Urban Employee Basic Medical Insurance(UEBMI)database from 2008 through 2011.A random sample of 30% of enrollees was used in this study.Descriptive analysis of variation trend of medical service utilization and expenditure in the appointed hospitals of medical insurance was conducted on the medical institutions level.Of the patient level,91 government-owned and general PHCs situated in the 6 districts of downtown Tianjin were chosen.Among them,patients who visited 49 PHCs which applied the pilot NEMP were identified to be intervention group,and patients visited the rest 42 PHCs which not applied were identified to be control group.A difference-in-differences(DID)approach based on the regression was employed to evaluate the difference of healthcare resource utilization and costs(both outpatient and inpatient)between two groups pre-and post-NEMP.The results on the medical institutions level showed that the number of outpatient per capita in PHCs was significantly increased from 2008 to 2011,which increased moderately in second-class and tertiary hospitals.In outpatient service,both the annual medication expenditure and total expenditure per capita were decreased.In inpatient service,the annual medication expenditure and total expenditure per capita were increased steadily in second-class and tertiary hospitals,while a slight decline after 2010 in PHCs.Of the patient level,although the number of outpatient visits increased significantly between the two groups pre-and post-NEMP,the total number of outpatient in intervention group did not change significantly compared with the control group after controlled the patient’s age,gender,working status and the health status indicated by by Quan-Charlson comorbidity index.There were also no significantly difference in outpatient total expenditure,medication expenditure and OOP expenditure between two groups.The impact of the NEMP to inpatient services is similar to that of outpatient services.The impact of the policy was identified from the changes in the total annual expenditure and the medication expenditure in all three level hospitals.Compared with the estimation of the average expenditure based on the evaluation of the PHCs which were conducted in previous studies,this study abled to eliminate the bias that the costs per visit may be influenced by the number of visits.This study found that the implementation of NEMP did not achieve its intended goal to guide patients to the PHCs,reduce the patients’ economic burden by decreasing the price of medicine,and thereby reducing the total expenditure and the OOP expenditure.Further suggests were pointed out that the essential medicines strategies developed by the Chinese government should be fine-tuned through monitoring and evaluations,and a dynamic essential medicine list selection mechanism should be built up.The basic medication production and supply security problems should be solved through a multi-attributes management.Reform of the mode of the medical insurance payment were also warrant to solve the problem of clinical demand shortages.The education of the essential medicine to PHCs physicians also plays a role in developing the NEMP.