The impact of long-term prescription policy on primary care utilisation and costs among hypertensive patients in China: a six-year longitudinal study.

Abstract

Background: China has recently implemented a long-term prescription policy as a component of the family doctor system in order to strengthen chronic disease management. In this study, we evaluated the net policy impact on health care utilisation and costs at community health centres (CHCs) among hypertensive patients.

Methods: The study population included 164 857 hypertensive patients from a provincial capital city in Eastern China, with an average age of 69.93 years in 2014. We collected their health care utilisation and costs from 1 January 2014 to 31 December 2019 from the medical insurance claims database. The long-term prescription policy, implemented in 2018, allows patients registered with family doctors to obtain up to three-month prescriptions. We applied the multi-stage difference-in-differences model to examine the policy's impact, comparing health care utilisation and costs between those eligible and for the long-term prescription policy and those who are not.

Results: The long-term prescription policy significantly reduced hypertensive patients' annual outpatient visits by 2.47 at CHCs and 0.18 at pharmacies, as well as prolonged the interval of prescriptions by 3.10 days at CHCs. It decreased the annual drug costs at pharmacies by 47%, but there was no significant effect on the annual outpatient costs at CHCs. Meanwhile, we did not observe the impact of the long-term prescription policy on patients' annual number of hospitalisations.

Conclusions: The long-term prescription policy mainly affected patients' health care utilisation at CHCs and did facilitate patients with chronic diseases to refill drugs conveniently. The policy impact on patient health outcomes needs to be further observed and more attention should be given to the factors that may influence family doctors' behaviour in delivering the long-term prescription service.