The Medical Expenses For Rheumatoid Arthritis In Liaoning And The Impact Research Of “Zero Markup Drug Policy” On The Disease Burden Of Rheumatoid Arthritis

Objective:Rheumatoid Arthritis（RA）has long course and needs long-term treatment.RA patients may suffer from different degree of limb deformity,which affects their ability to work and even results in some patients losing their ability to work,thus bringing the serious economic burden to the patient and the country.In this study,we calculated the expenses of RA in Liaoning province to have a knowledge of the disease burden of RA in Liaoning province.Chinese government implemented addition policy to keep the balance of hospital income and expenditure for a long time,but it also led to increasing the cost of drugs,abuse of drugs,and repaid increase of proportion of drugs and the total medical expenses in pursuit of profit.Thus,many patients complained about“Kanbinggui”.Therefore,the Chinese government abolished the drug-addition policy and implemented the Zero Markup Drug Policy（ZMDP）.ZMDP reduced the medical expenses of patients with chronic diseases（such as hypertension,diabetes,etc.）according to recent literature.However,there is lack of study about the impact of ZMDP on the medical costs of patients with rheumatoid arthritis.Thus,we aimed to explore the impact of ZMDP on RA disease burden.Methods:This research was based on the SHA2011,and we calculated and analyzed the medical costs of patients with rheumatoid arthritis in Liaoning Province from Liaoning Medical Expense Database.Grey relational analysis can quantitatively describe the relative changes among the systems or among the factors in the system,and measure the correlation between the factors affecting the system.Grey correlation analysis was used to sort the influencing factors of inpatient cost and outpatient cost of patients with rheumatoid arthritis in Liaoning province.Interrupted Time Series Analysis（ITSA）is a quasi-experimental research design.It can accurately evaluate the policy effect,intuitively simulate the immediate and trend impact of the policy.A single-group ITSA was adopted to quantify the ZMDP effect on RA disease burden.ZMDP in Liaoning province was fully implemented on August 26,2017.The time from January 2015 to August 2017 was as the pre-intervention period and the time from September 2017 to December 2019 was as the post-intervention period.Hospital expenditures,drug expenditures,out-of-pocket expenses and the proportion of drugs costs on hospital costs were used as outcome variables to model the segmented regression model.Results:1.The treatment costs of rheumatoid arthritis patients in Liaoning Province increased year by year,and the medical expenses mainly flowed to hospitalization services.The cost of treatment mainly flowed to general hospitals and traditional Chinese medicine hospitals,with few on primary medical institutions and other medical institutions.Medical expenses mainly concentrated in the age group of 40 to 70 years old,and the cost of female treatment was significantly higher than that of male treatment.2.The factors affecting the outpatient treatment cost of patients with rheumatoid arthritis in Liaoning Province were as following:drug cost（0.96）,check cost（0.76）,test cost（0.69）,and other costs（0.62）.The factors influencing the hospitalization cost of patients with rheumatoid arthritis in Liaoning Province were as following:bed fees（0.95）,drug cost（0.94）,test cost（0.94）,check cost（0.91）,other cost（0.89）,diagnosis cost（0.87）,operation cost（0.81）,treat cost（0.73）,and nursing cost（0.68）.3.The results of interrupted time series analysis showed that the implementation of the drug zero-addition policy immediately reduced the proportion of drugs（β₂=-7.28,P<0.01）.However,there was no significant downward trend in the proportion of drugs after the implementation of the policy from the long-term trend（β₁+β₃=-0.27,P=0.39）.The zero-markup drug policy reduced the drug cost by 660.90 yuan per person per visit（β₂=-660.90,P<0.05）,but there was no significant downward trend of drug costs in the long term（β₁+β₃=-42.74,P=0.27）.The zero-drug-markup policy had no immediate effect on hospitalization costs（β₂=-532,P=0.17）,but it reduced hospitalization costs from the long-term trend（β₁+β₃=-194.61,P<0.01）.The zero-addition policy had no immediate effect on the out-of-pocket expenses of inpatients with rheumatoid arthritis（β₂=406.42,P=0.28）,but the out-of-pocket expenses of inpatients with rheumatoid arthritis were reduced from long-term trend（β₁+β₃=-150.98,P<0.05）.Conclusion:1.The burden of rheumatoid arthritis treatment costs was heavy and increasing year by year.And the proportion of outpatient costs increased year by year.The majority of RA medical costs were focused on hospitalization costs.The total medical expenses of rheumatoid arthritis were mainly contributed to provincial and municipal medical institutions,but were less distributed in district and county medical institutions and primary medical institutions.The total medical expenses of rheumatoid arthritis were mainly spent on general hospitals and hospitals of traditional Chinese medicine.Total medical costs for rheumatoid arthritis were spent on the age group from40 to 70.Female RA medical costs were more than male.And we suggested patients go to different hospitals to reduce the pressure of large hospitals,and strengthen the prevention and control of rheumatoid arthritis in people aged 40-70,especially women.2.The top three influencing factors related to outpatient costs of patients with rheumatoid arthritis were drug costs,examination costs and laboratory costs.The top three factors associated with hospital costs in patients with rheumatoid arthritis were bed costs,drug costs and laboratory costs.3.The zero-markup drug policy immediately reduced the drug cost and drug proportion of rheumatoid arthritis patients.The hospitalization cost and out-of-pocket expenses of rheumatoid arthritis patients gradually decreased after the implementation of the policy from long-term trend.It is suggested that the medical burden of rheumatoid arthritis patients reduced to a certain extent,but the control of drug proportion and drug cost might be superficial.Only by breaking the monopoly of public hospitals in the medical service and drug purchase and sale market,and promoting the administration of public hospitals can the"profit-seeking behavior"of hospitals be changed,and the proportion of drugs be controlled and the price of drugs reduced.In addition,it is of vital importance for medical burden reduce to improve the medical insurance service system,increasing the reimbursement rate of hospitalization expenses of medical insurance for rheumatoid arthritis,improve the construction of the medical and health system,timely adjust the reform strategy,increase health input,strengthen the compensation for medical institutions,and supervise the fees of medical institutions.It is also essential to establish a united mechanism between the zero-addition drug policy and other measurements such as centralized drug bidding and purchasing.Besides,it is of necessity to adjust the structure of medical service charges,and improve the salary and performance appraisal of medical staff to reduce the medical burden of patients.