药品集采改革、医疗负担与医疗公平——来自医院处方的微观证据

Abstract

China's national volume-based drug procurement (VBDP) reform serves as a key entry point for addressing the issue of inflated drug prices and deepening the supply-side reform of healthcare services. This paper develops a unified analytical framework of "price shock-behavioral response-outcomes in medical expenditure and health equity". Using micro-level prescription data at the patient-physician level and exploiting the staggered implementation of 17 procurement batches, we investigate the comprehensive impact of the reform on drug prices and patients' medical burden. The main findings are as follows. First, the reform generates substantial price reductions, with average drug prices declining by more than 70%, and produces significant spillover effects on non-selected drugs. Second, the reform effectively reduces the medical burden of outpatient patients, with larger benefits observed among low-income groups and rural residents, thereby contributing to promoting health equity. Third, a "seesaw effect" arises, as hospitals and physicians respond strategically by shifting the loss of drug revenue to other non-pharmaceutical charges, which partially offsets the burden-reducing effects of the reform. Overall, the findings of this paper confirm the positive role of the volume-based drug procurement reform in reducing high medical costs, while also revealing its potential impact on the behavior of healthcare providers. These insights provide empirical evidence for further optimization of the volume-based drug procurement system.