{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T15:16:13Z","timestamp":1787584573511,"version":"build-2736575974"},"reference-count":48,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T00:00:00Z","timestamp":1761782400000},"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. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>As one of the most severe clinical manifestations of osteoporosis, osteoporotic hip fractures often require surgical treatment and result in high medical costs. The hospitalization expenses for patients with osteoporotic hip fractures in China have been on the rise; however, there are few reports on the structural variations in hospitalization costs for these patients and the correlation between total and individual expenses. This research aims to analyze the structure of hospitalization costs and their changes over an extended period in Shanghai, China, and to investigate the impact of the national volume-based procurement (NVBP) policy on costs associated with osteoporotic hip fractures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data were obtained from the Shanghai Health Statistics Center, which includes hospitalization records for patients at all medical institutions in Shanghai from January 2017 to December 2022. Structural variation analysis was utilized to assess the shifts in yearly hospitalization cost composition, while new gray correlation analysis was employed to explore the degree of association between individual and total costs across both overall and various levels of hospitals. Additionally, we evaluated the effects of the NVBP on total and individual hospitalization costs using interrupted time series analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      While there was a decline in 2022, medical consumable costs accounted for over 59% of total inpatient costs for osteoporotic hip fractures and consistently demonstrated the highest correlation with total hospitalization costs in Shanghai from 2017 to 2021. Drug costs not only had the highest contribution rate to overall inpatient expenses during the years 2017\u20132018 (44.22%) and 2020\u20132021 (36.76%) but also held the top position in the contribution rate of structural variation (CRSV) from 2017 to 2022 (45.77%). The stratification results at the hospital level indicated that drug costs in tertiary and secondary hospitals declined over 6\u202fyears, while primary hospitals only saw reductions in a few years. Furthermore, medical consumable costs for tertiary and secondary hospitals decreased in 2021\u20132022, with CRSVs of 23.36 and 37.91%; however, primary hospitals had higher medical consumable costs during this period. After the NVBP policy was implemented, total hospitalization costs significantly decreased by 5,022.088 yuan (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). Additionally, hospitalization costs exhibited a significant downward trend over time, decreasing by 596.114 yuan after the intervention (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). Medical consumable costs also exhibited a declining pattern regarding both immediate effects and long-term patterns after the reform, with an average decrease of 290.448 yuan (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Although the medical consumable costs related to osteoporotic hip fractures made up the largest portion of total expenditures for inpatients, their share declined due to the implementation of the NVBP. Despite the significant structural variation in drug costs, they still represented the second-largest part of total hospitalization expenditures. Future policy should focus on addressing the rising hospitalization costs of osteoporotic hip fractures, particularly those associated with medical consumables and drugs. Besides, additional regulations should be established based on the cost structures of medical institutions at various levels.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2025.1678817","type":"journal-article","created":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T05:24:29Z","timestamp":1761801869000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Analysis of structural variations and effects of the national volume-based procurement policy on inpatient costs: a real world study of osteoporotic hip fractures in Shanghai, China"],"prefix":"10.3389","volume":"13","author":[{"given":"Jing","family":"Yan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiujun","family":"Qin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinye","family":"Fang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fen","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bifan","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,30]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1056\/NEJMcp1513724","article-title":"Clinical practice. 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Evidence from China\u2019s compact county medical communities","volume":"24","author":"Cui","year":"2025","journal-title":"Int J Equity Health"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"1468606","DOI":"10.3389\/fpubh.2024.1468606","article-title":"A comparative study of hospitalization costs of TKA inpatients before and after National Volume-based Procurement in Guangdong, China: an interrupted time-series analysis","volume":"12","author":"Li","year":"2024","journal-title":"Front Public Health"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"894","DOI":"10.1001\/jama.2025.6003","article-title":"Osteoporosis: a review","volume":"334","author":"Morin","year":"2025","journal-title":"JAMA"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1007\/s11657-025-01607-3","article-title":"Temporal trends in acute care costs of hip fracture treatment from 2011 to 2021 in Japan","volume":"20","author":"Hatano","year":"2025","journal-title":"Arch Osteoporos"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"1661","DOI":"10.1007\/s00198-024-07140-2","article-title":"Epidemiology of hip fractures in Thailand","volume":"35","author":"Charatcharoenwitthaya","year":"2024","journal-title":"Osteoporos Int"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"104919","DOI":"10.1016\/j.healthpol.2023.104919","article-title":"A systematic review of policies regulating or removing mark-ups in the pharmaceutical supply and distribution chain","volume":"138","author":"Joosse","year":"2023","journal-title":"Health Policy"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1016\/j.socscimed.2018.06.007","article-title":"Intended and unintended impacts of price changes for drugs and medical services: evidence from China","volume":"211","author":"Fu","year":"2018","journal-title":"Soc Sci Med"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"e073913","DOI":"10.1136\/bmjopen-2023-073913","article-title":"Differences in inpatient performance of public general hospitals following implementation of a points-counting payment based on diagnosis-related group: a robust multiple interrupted time series study in Wenzhou, China","volume":"14","author":"Zhu","year":"2024","journal-title":"BMJ Open"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1186\/s12962-020-00229-5","article-title":"The effect of different classification of hospitals on medical expenditure from perspective of classification of hospitals framework: evidence from China","volume":"18","author":"Li","year":"2020","journal-title":"Cost Eff Resour Alloc"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"821","DOI":"10.1177\/1060028020970518","article-title":"Economic burden of osteoporosis-related fractures in the US Medicare population","volume":"55","author":"Williams","year":"2021","journal-title":"Ann Pharmacother"},{"key":"ref48","year":"2025"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1678817\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T05:24:29Z","timestamp":1761801869000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1678817\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,30]]},"references-count":48,"alternative-id":["10.3389\/fpubh.2025.1678817"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1678817","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,30]]},"article-number":"1678817"}}