The Impact of National Volume-based Procurement on Healthcare Expenditure for Hypertensive in Guangzhou, China

Background In 2019, the Chinese government launched the national volume-based procurement (NVBP). 7 antihypertensive drugs were selected in the first round of NVBP. This study aimed to evaluate the impact of NVBP on the expenditure of patients with hypertension. Methods The Guangzhou claims data of patients diagnosed with hypertension was extracted from the China Health Insurance Research Association (CHIRA) database, covering 36 months from January 2017 to December 2019. Adopting the interrupted time series (ITS) and difference-in-difference (DID) approach, we evaluated the impacts of the NVBP policy on total healthcare expenditure, health insurance expenditure, and patients’ financial burden at both the collective level and individual level. We also examined how patients and health facilities’ characteristics affected the association. Results At the collective level, we found that the introduction of the NVBP policy reduced total healthcare expenditures and health insurance expenditures for outpatient services by 11.40% and 15.63%, respectively (all p<0.01), while it appeared to have no impact on inpatient services. At the individual level, the DID analysis showed that the total healthcare expenditures per visit decreased by 35.40% (p<0.01), among which healthcare insurance expenditures decreased by 36.81% and out-of-pocket expenditures decreased by 24.65% for outpatients treated with NVBP-list drugs. However, we did not detect any changes in healthcare expenditures per admission. In subgroup analysis, we found a greater decrease in healthcare expenditure per visit for secondary and tertiary hospitals, as well as patients with Urban and Rural Residents Medical Insurance (URRMI). Conclusion This study provides additional evidence that the NVBP policy was associated with achieving cost-containment, alleviating patients’ burdens, and relieving pressure on health insurance funds, which provides important lessons for other countries that are seeking to improve their drug procurement processes. However, the impact of NVBP policy is likely to differ across facilities level and health insurance schemes.