Affiliations: Management Department, Beijing University of Chinese
Medicine, Beijing, China | National Institute of Hospital Administration, MoH,
Haidian District, Beijing, China
Note: [] Corresponding author: Jing Sun, National Institute of Hospital
Administration, MoH, 38 Xueyuan Road, Haidian District, Beijing, China. Tel.:
+86 13910017574; Fax: +86 10 67608614; E-mail: sunjingx@yahoo.com
Abstract: 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.
Keywords: Mark-up, government subsidy, community health facility
