The revenue of public hospitals in China mainly come from medical service charge, drug markup and financial subsidy. Drug markup was the most important part, while the price of medical services was under strict regulation. This study aims to investigate the current situation of medical service price adjustment after abolishing the drug markup in 2017. A literature review were conducted with 31 provinces involved. Issues related to medical services price adjustment like organization structure, procedures, period, startup mechanism, pricing and adjustment method, coordination and monitoring were covered in the expert consultations and case studies in selected provinces. Raising the medical service (not including drugs) price in general gained consensus in the wave of public hospital reform in order to compensate the loss of drug markup. While the financial subsidy maintaining at a historical level (about 10% or less of revenue), 80% or higher proportion of revenue relied on the rise of medical service, with the remaining compensated by strengthening internal cost management. Within the thousands of medical service items, those with high technical value such as nursing care and operation were in the list of increasing price, while those depending more on equipment like laboratory tests were to be in the price-cut list. Currently in most provinces the price adjustment were judged by experts and to some extent made reference to neighboring provinces with varied adjustment cycle and startup mechanism (eg., in relation to CPI). Decentralization of price management in some provinces also made the medical service price adjustment sophisticated. Dynamic adjustment mechanism of medical service price is still under construction in order to appropriately reflect the change of cost and hospital revenue structure, as well as the balancing of decisions among hospital revenue, financial burden of patients and medical insurance expenditure.

To investigate the long-term change of medical services price and explore the correlation between Consumer Price Index (CPI) and medical services price index in China and other countries including the United States, Germany, United Kingdom, Japan and Singapore, with the aim to inform China's medical services price regulation. Medical services price index is one component of CPI and is used to reflect the change in medical services price. Related data since 1997 were collected from the official websites of national statistical office of the abovementioned countries. In addition to descriptive statistics analysis, the standard time series correlation methods including cointegration test, Granger causality test, impulse response function and variance decomposition based on vector error-correction model were used to explore the correlation between CPI and medical services price index. During the past 20 years, China has the largest average increase in medical services price, while the average growth rate of medical services price in other countries, especially in Germany and Japan, were much lower. The study found that there is a long-term correlation between CPI and medical services price index in China. The results of Granger causality test indicate that CPI and medical services price index are mutually causal. And the variance decomposition results suggested that medical services price explain about 20 percent of CPI variance in China. There is no significant correlation between the CPI and medical services price index in Germany and Japan. When compared with the countries with classical healthcare systems, China had seen much higher growth rate of medical service price which was statistically time-series correlated with CPI. The historical data of China showed 3-year lag for CPI to significantly influence medical service price, while only one-year lag for the significant influence of medical service price to be accounted in CPI.

Thrombocytopenia is a serious clinical conditions after cancer chemotherapy and the condition could result potential drug dose reduction and treatment delay. At the same time, thrombocytopenia can affect the quality of life of patients and increase healthcare cost substantially. In China, recombinant human thrombopoietin (rhTPO) was recommended to treat chemotherapy-induced thrombocytopenia (CIT) by China cancer chemotherapy expert panel in 2014. The objective of this study is to assess the cost-effectiveness of rhTPO versus IL-11 in treating Chinese CIT patients. An economic model was constructed to assess the cost-effectiveness of rhTPO and IL-11 in the treatment of CIT. All data required by the model were derived from literature review and key opinion leader (KOL) survey. The clinical efficacy data were obtained from published literature. Cost data were collected from Chinese leading hospitals located in Beijing, Shanghai, Guangzhou, Jinan, Wuhan and Chengdu with a total of 51 experts interviewed in the 6 cities. A one-way sensitivity analysis was conducted. The total medical cost of rhTPO and IL-11 is RMB 8533.3 and RMB 6820.9 respectively. The incidence rate of grade III thrombocytopenia is 39.7%, 67.6% and grade IV thrombocytopenia is 11.1%, 35.2% respectively of rhTPO and IL-11 group. Compared with IL-11, the increased cost for one grade III thrombocytopenia patient and grade IV thrombocytopenia patient averted by rhTPO is RMB 5990 and RMB 7100 respectively. Both of which are lower than the calculated cost from questionnaires collected from the 51 experts (The cost for one grade III thrombocytopenia patient and grade IV thrombocytopenia patient averted is RMB 6190 and RMB 10650 yuan respectively). With rhTPO cost changing 10% on the basis value, the model shows robustness according to the result. RhTPO is a cost effective treatment compared with IL-11 in China CIT patients. The sensitivity analysis results indicated that the model is robust.

To evaluate the cost-effectiveness of a new covered stent (WILLIS) vs. endovascular coil occlusion for the treatment of intracranial aneurysms in china. A decision tree model was constructed and the treatment impact was projected up to 6 months. 88 endovascular coil occlusion treated initial intracranial aneurysms patients and 34 recurrence intracranial aneurysms patient (with aneurysm diameter > 7 mm) charts were reviewed and direct medical cost data were collected from hospital information system in multi-hospitals in 12 cities in China. Direct medical cost data, including drug cost, medical device cost, daily bed expenses, nursing fee, and examination cost were abstracted from the charts. The aneurysm recurrence rates by WILLIS and Coil treatments were obtained through literature review. The mortality rate of intracranial aneurysms recurrence, and side effects rates of treatments were collected through a direct expert survey. The main summary measure in this evaluation was incremental cost per death avoided. One way sensitivity analysis was performed to determine the robustness of the results. The total direct medical cost was 141,582.95 RMB and 177,407.35 RMB for Willis and coil occlusion treatments respectively; the recurrence rate of intracranial aneurysms was 0% and28.9% for Willis and coil occlusion treatments in Chinese patients respectively; Relapse mortality of intracranial aneurysms is 0.2% in Chinese patients. The result suggests a dominant effect of Willis treatment over coil occlusion with an incremental cost-effectiveness ratio (ICER) of -63055263.7RMB/avoided death. This indicates that Willis treatment has demonstrated better efficacy and lower overall costs. The one-way sensitivity analysis didn’t change the conclusion, indicating the robustness of the results. Compared with endovascular coil occlusion, a new covered stent (WILLIS) improves clinical outcomes and reduces overall medical costs for the treatment of Chinese intracranial aneurysms patients (Diameter > 7 MM).