Objective To systematically review the effect of implementing the medicines zero mark-up policy in Chinese public hospitals.Methods CNKI, WanFang Data, VIP, Sinomed, Web of Science, PubMed and EMbase databases were electronically searched to collect quantitative evaluations of the effect of implementing the medicines zero mark-up policy in Chinese public hospitals from inception to October 30th, 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Descriptive analysis was then performed.Results The existing evidence on the effect of implementing the medicines zero mark-up policy in Chinese public hospitals was from 3 studies based on national samples and 7 provincial level studies in Beijing, Shannxi and Fujian. After the implementation of the medicines zero mark-up policy, all included studies found that the medicines expenditure and the proportion of medicines expenditure to the total expenditure per outpatient visit or per hospitalization decreased. The expenditures of medical supplies, tests & examinations per outpatient visit or per hospitalization increased, and the medical expenditure per outpatient visit or per hospitalization increased in Beijing. The hospital annual revenue generated from medicines and its proportion to the total annual revenue both decreased across the country. Although the government allocated increased subsidy to compensate the revenue reduction of the public hospitals due to the implementation of the medicines zero-mark-up policy, the total annual revenue of traditional Chinese medicine hospitals at the county level across the country still decreased significantly.Conclusions Based on the available evidence, we conclude that the policy objective of abolishing the mechanism of "compensating medical care with revenue generated from prescribing medicines" is achieved, while that of establishing a scientific compensation mechanism for public hospitals are partially achieved. Compared with other regions, Beijing has appropriately adjusted the prices of medical care while removing the mark-up of medicines, thus is a contributor to the establishment of a scientific compensation mechanism for public hospitals.
ZHANG Yuou, CHENG Hanchao, WANG Jichao, SUN Jing, LIU Yuanli. Effect of implementing of the medicines zero mark-up policy in Chinese public hospitals: a systematic review. Chinese Journal of Evidence-Based Medicine, 2021, 21(5): 546-558. doi: 10.7507/1672-2531.202011125