EFFECT EVALUATION OF COMPREHENSIVE HEALTHCARE REFORM IN BEIJING, CHINA

Public hospitals in China have historically relied on profits from high markups on drug and medical consumables sales, which contributed to escalating medical expenditures and placed heavy financial burdens on patients. Aiming to contain escalating medical expenditures and reorient public hospital services more toward the public interest, Beijing implemented two rounds of healthcare reform in 2017 and 2019. The first round focused on separating drug sales from hospital revenue (reform 1), and the second round extended to included zero markup on medical consumables and price adjustments for medical services (reform 2). This study evaluated how these two rounds of reform have affected patients, physicians, and public hospitals. We determined the effects of controlling the excessive growth of medical expenditures, how medical expenditures and hospital revenue structures have changed, estimate the effect of guiding patients to go to primary healthcare facilities instead of tertiary hospitals, and determine how to control the excessive growth of expenditures in terms of changing medical service utilization. The monthly observational data for each hospital from January 2016 to December 2019, covering 354 healthcare facilities, were analyzed to estimate the effect of reform on changes in medical expenditures, medical revenue structures, and the number of outpatients and inpatients. A panel-interrupted time series model was used for analysis. Questionnaires and semi structured interviews were then conducted to assess the effectiveness of the reforms. Results showed that Beijing’s reforms restrained rising health care expenditures and reshaped hospitals’ revenue structures by reducing the proportion of drug and consumable sales and increasing the proportion of medical consultation fees that made up hospital revenues and by leading patients to seek treatment at primary care facilities. In these ways, we found that Beijing’s comprehensive healthcare reforms have been effectively implemented and are progressing as intended. This study could provide some insight into healthcare system reform. A dynamic price-adjustment mechanism for healthcare services should be established; changes in service delivery should be monitored further, and service quality should be evaluated thoroughly; a DRG-based payment method should be promoted