ArticleBioMed research international2020
The Effects of County Public Hospital Reform on the Consumption and Costs of Antibiotics: Evidence from a Quasinatural Experiment in Jiangsu, China.
Article in BioMed research international, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.
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Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Barriers and facilitators of implementing interventions to improve appropriate antibiotic use in low- and middle-income countries: a systematic review based on the Consolidated Framework for Implementation Research.Implementation science : IS · 2022Pooled it
- Barriers and facilitators of the implementation for the antimicrobial Social Norm Feedback (SNF) intervention strategy in primary care institutions: a qualitative study based on the Consolidated Framework for Implementation Research (CFIR).Antimicrobial resistance and infection control · 2025Article
- Microbial profile and antimicrobial resistance patterns of ocular infection pre/during and post the COVID-19 pandemic.Frontiers in medicine · 2025Article
- The impacts of public hospital comprehensive reform policies on hospital medicine cost, revenues and healthcare expenditures 2014-2019: An analysis of 103 tertiary public hospitals in China.Frontiers in health services · 2023Article
- Differences in service and antibiotics use following symptomatic respiratory tract infections between 2016 and 2021 in rural Anhui, China.Epidemiology and infection · 2022Article
- Pharmaceutical Sales Representatives in the United States and China: The Need for Professional Public Space.Health care analysis : HCA : journal of health philosophy and policy · 2022Article
- The impact of pharmacist-led antimicrobial stewardship program on antibiotic use in a county-level tertiary general hospital in China: A retrospective study using difference-in-differences design.Frontiers in public health · 2022Article
- The Impact of Sanming Healthcare Reform on Antibiotic Appropriate Use in County Hospitals in China.Frontiers in public health · 2022Observational
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Authors and funding
6 authors.
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Abstract
backgroundOveruse of antibiotics is a major driver for rapid spread of antimicrobial resistance worldwide, particularly common in China. The close linkage between hospital revenue and sales of drugs has become the key incentive for overprescription of antibiotics. Since 2009, the Chinese government implemented a series of measures to cut off the link, including removing the markup of drugs, increasing financial subsidies, and adjusting charges for medical service.
objectiveTo evaluate the impacts of county public hospital reform on the consumption and costs of procured antibiotics in Jiangsu province.
methodsA quasiexperiment design was conducted in Jiangsu province where 99 county public hospitals implemented the reform successively in different periods. Of these, 37 county public hospitals implemented the reform since January 2013, which were regarded as the intervention group, and the remaining 62 hospitals were included in the control group. A difference-in-differences (DID) analysis with generalized linear regressions was used on the procurement records of antibiotics from January 2012 to December 2013. Modified Park test was used for family distribution and Box-Cox test for log link. Placebo tests were employed to test the common-trend hypothesis of two groups.
resultsFor the intervention group, the average volume of procured restricted antibiotics and injectable antibiotics increased by 24.12% and 2.75% while the costs increased by 19.01% and 9.09%, respectively. The average costs per DDD of restricted and injectable antibiotics were much higher than unrestricted and oral antibiotics. The DID results showed that the reform had a positive impact on the average volume (
conclusionsThe reform is effective in reducing the consumption and costs of unrestricted and oral antibiotics, but it has failed to reduce the consumption and costs of expensive restricted and injectable antibiotics, leading to increased burden of diseases. It is critical that the health policy initiatives can deincentivize overuse of antibiotics at both hospital and individual physician's levels. The reform should enforce government financial support, improve hospital governance, optimize performance evaluation, and establish specialized management approach for antibiotic use.
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