Study on the effect of “zero mark-up” policy on medicines in Beijing community health facilities

Objective: “Zero mark-up policy” was introduced in Beijing community health centers (CHCs) with three government subsidy approaches: fixed subsidy (FS), income-linked subsidy (IS) with income and expenditure controlled by government, and self-financing with mark-up compensation from government purchasing services (GPS). This study analyzes the cost containment effect and its effect on the operation of CHCs and staff moral.

Methods: CHCs are randomly sampled and distributed in 3 government subsidy approach groups. The effect is measured with changes of medicine use and cost, income of facilities and staff before and after the policy in each group, and compared among groups.

Results: Cost proportion of zero mark-up medicines per visit in FS/IS/GPS is 75.4%/57.8%/52.6% by 2009. Medicines cost per visit in FS and IS reduces 18.7% and 1.9% by 2007 (P=0.001, α=0.05, t test), and rebounds in 2008–9; GPS increases 25.2% by 2007 and keeps growing. Between 2006 and 2009, government subsidy is always the highest in FS and lowest in GPS. The annual salary of FS is always the highest and increases the fastest.

Conclusions: The “zero mark-up policy” contains medicines costs. FS is more effective than IS and GPS. GPS causes lower willingness to use zero mark-up medicines. FS and IS need to improve the work enthusiasm. IS has mixed effect.