{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T06:56:02Z","timestamp":1790751362989,"version":"4.1.0"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>China's national volume-based procurement (NVBP) policy reduced prices for selected medicines, but national aggregate drug-cost trends are exposed to concurrent reforms and nonlinear prepolicy trajectories. We assessed public-hospital drug-cost trajectories around 2019 and explored hospital revenue structure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This uncontrolled ecological interrupted time-series study used a balanced panel of 31 province-level units from 2011 through 2024 (434 province-years). Province fixed-effects segmented regressions estimated immediate level and annual trend changes in per-encounter drug costs and drug-cost shares. Sensitivity analyses examined nonlinear and piecewise pretrends, non-drug costs as a control series, calendar-year fixed effects in drug-versus-non-drug comparative models, consumer-price-index deflation, multiple testing, and influential years. Revenue structure was described in 35 observations from 4 data-available provinces, with wild cluster bootstrap inference reported only as exploratory.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      No primary outcome showed a clear immediate 2019 level change (all\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;gt;\u2009.05). Under the prespecified single-linear-pretrend model, annual trends changed by \u22121.67 Chinese yuan (CNY) per outpatient visit [95% confidence interval (CI), \u22122.70 to \u22120.63] and \u2212164.53 CNY per inpatient discharge (95% CI, \u2212199.80 to \u2212129.26). In the linear model, the model-implied 2024 differences were \u22125.31 CNY per outpatient visit (95% CI, \u221211.70 to 1.07;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.100) and \u2212753.18 CNY per inpatient discharge (95% CI, \u2212924.76 to \u2212581.60;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u2009.001). However, results were highly sensitive to pretrend form: with a 2016-2018 piecewise pretrend, corresponding changes were 1.64 CNY (95% CI, 0.27 to 3.02) and 17.11 CNY (95% CI, \u221233.46 to 67.68). Inpatient non-drug cost also changed substantially (\u2212409.50 CNY\/year; 95% CI, \u2212483.03 to \u2212335.97), and the inpatient drug-versus-non-drug differential trend change was not significant after calendar-year fixed effects (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.488). Drug-cost shares remained below 2011 levels but declined more slowly after 2019 in all specifications. The 4-province revenue trend-change interval crossed zero with wild cluster bootstrap inference (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.055). Conclusion: The single-linear ITS suggested post-2019 changes in aggregate drug-cost trajectories, but nonlinear pretrends and synchronous non-drug changes materially weakened their specificity to NVBP. These annual ecological data support temporal description, not attribution of the observed breakpoint to NVBP alone.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1970115","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T06:04:54Z","timestamp":1790748294000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Drug-cost trajectories after national volume-based procurement in Chinese public hospitals: a 31-province interrupted time-series analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Jing","family":"Mao","sequence":"first","affiliation":[{"name":"Shanghai Sixth People\u2019s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guangqi","family":"Liu","sequence":"additional","affiliation":[{"name":"Shanghai Sixth People\u2019s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"l4015","DOI":"10.1136\/bmj.l4015","article-title":"Reforming public hospital financing in China: progress and challenges","volume":"365","author":"Xu","year":"2019","journal-title":"Br Med J"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1192","DOI":"10.1016\/S0140-6736(19)32136-1","article-title":"10 years of health-care reform in China: progress and gaps in universal health coverage","volume":"394","author":"Yip","year":"2019","journal-title":"Lancet"},{"key":"B3","year":"2019"},{"key":"B4","doi-asserted-by":"publisher","first-page":"e011535","DOI":"10.1136\/bmjgh-2022-011535","article-title":"Improving access to medicines and beyond: the national volume-based procurement policy in China","volume":"8","author":"Zhu","year":"2023","journal-title":"BMJ Glob Health"},{"key":"B5","doi-asserted-by":"publisher","first-page":"e005519","DOI":"10.1136\/bmjgh-2021-005519","article-title":"Lowering drug prices and enhancing pharmaceutical affordability: an analysis of the national volume-based procurement effect in China","volume":"6","author":"Yuan","year":"2021","journal-title":"BMJ Glob Health"},{"key":"B6","doi-asserted-by":"publisher","first-page":"7724","DOI":"10.34172\/ijhpm.2023.7724","article-title":"Impact of China\u2019s national volume-based procurement on drug procurement price, volume, and expenditure: an interrupted time series analysis in Tianjin","volume":"12","author":"Zhao","year":"2023","journal-title":"Int J Health Policy Manag"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1275","DOI":"10.1186\/s12913-021-07143-3","article-title":"The impact of \u201c4\u2009+\u20097\u201d volume-based drug procurement on the volume, expenditures, and daily costs of antihypertensive drugs in Shenzhen, China: an interrupted time series analysis","volume":"21","author":"Yang","year":"2021","journal-title":"BMC Health Serv Res"},{"key":"B8","doi-asserted-by":"publisher","first-page":"9415","DOI":"10.3390\/ijerph17249415","article-title":"The impacts of national centralized drug procurement policy on drug utilization and drug expenditures: the case of Shenzhen, China","volume":"17","author":"Chen","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1883","DOI":"10.1186\/s12889-021-11882-7","article-title":"Influence of Chinese national centralized drug procurement on the price of policy-related drugs: an interrupted time series analysis","volume":"21","author":"Wang","year":"2021","journal-title":"BMC Public Health"},{"key":"B10","doi-asserted-by":"publisher","first-page":"S605","DOI":"10.1016\/j.jval.2019.09.1065","article-title":"Optimizing China BMI funds through drug volume-based procurement: understanding the result, impact and challenges","volume":"22","author":"He","year":"2019","journal-title":"Value Health"},{"key":"B11","year":"2022"},{"key":"B12","doi-asserted-by":"publisher","first-page":"e0338409","DOI":"10.1371\/journal.pone.0338409","article-title":"Impact of Chinese national centralized volume-based drug procurement policy on health costs and utilization: an interrupted time series analysis using panel data (2009\u20132022)","volume":"20","author":"Jiang","year":"2025","journal-title":"PLoS One"},{"key":"B13","doi-asserted-by":"publisher","first-page":"e048308","DOI":"10.1136\/bmjopen-2020-048308","article-title":"What is the major driver of China\u2019s hospital medical expenditure growth? 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