Analysis of the Characteristics and Influencing Factors of High-Value Drugs Used in and Outside Hospitals Under the"Dnal-Channel"Management
Objective:The paper compared the utilization characteristics and trends of the high-value drugs between hospital outpatients(in-hospital)and retail pharmacies(out-of-hospital)under the"dual-channel"policy,and empirically analyzed the factors influencing patients'out-of-hospital medication behavior of high-value drugs at the individual level.Methods:We collected medical insurance reimbursement records of all insured patients in Weihai City,Shandong Province from 2019 to 2023 and relevant policy documents.Patients who had utilized and reimbursed the high-value drugs within the five years were selected as study samples.Descriptive statistical analysis was used to compare the differences in the number of patients,visits,and costs between the two channels(in-hospital and out-of-hospital)and across the five civil years.The Heckman sample selection model was employed to quantify hospital medication behavior from two aspects:the probability of out-of-hospital drug procurement and the proportion of out-of-hospital medication,and identify the influencing factors of out-of-hospital medication behavior from the dimensions of individual characteristics,disease characteristics,and treatment characteristics.Results:From 2019 to 2023,the average annual growth of the number of patients,visits,and costs for high-value drugs in Weihai City was 47.67％,78.72％,and 24.89％,in which out-of-hospital channel increased by 81.95％,135.77％,and 63.57％and the corresponding proportion reached 87.41％,88.60％,and 88.05％by 2023.The results of Heckman model showed that compared to 2019,the out-of-hospital medication behavior for high-value drugs became more prominent from 2020 to 2023(P＜0.01).The probability of out-of-hospital drug procurement has significantly increased by 82.5％,149.5％,179.7％,and 169.9％in the past four years.Conclusions:The"dual-channel"policy promotes a rapid utilization increase of the high-value drugs,with a prominent trend of prescription outflow.Patients'out-of-hospital medication behavior has significant age trends,and is driven by factors such as cancer,heavy medication burden,long medication cycles,and low frequency of in-hospital medication.
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