, Volume 32, Issue 3, pp 257–264 | Cite as

Time Trends and Determinants of Pharmaceutical Expenditure in China (1990–2009)

  • Lizheng Shi
  • Heidi Y. Yang
  • Gang Cheng
  • Qingyue MengEmail author
Original Research Article



Pharmaceutical policy reform is currently one of the primary areas of health reform in China. The national pharmaceutical policy of China has multiple objectives: to develop the domestic pharmaceutical industry and encourage innovation, to control escalation of total pharmaceutical expenditures (TPE) which constitute a substantial component of total health expenditures (THE), and to ensure access to essential medicines for poor and uninsured patients. The current pharmaceutical system has been criticized for its high costs, questionable prescribing practices, and poor regulation of drug quality. This study aims to examine the time trends and influential factors of TPE in China.


Data from the 2010 China National Health Accounts Report and the 2010 China Health Statistics Year Book were used in the analysis. Time trends of TPE as a share of THE (TPE/THE), of gross domestic product [GDP] (TPE/GDP), and the relationship between TPE/THE and GDP were examined. The growth of TPE was examined after adjusting for health care utilization and GDP. The determinants of the TPE/THE and the TPE/GDP between 1990 and 2009 were investigated by two time-series regression models including the amount of prescriptions dispensed (using proxy variables of health utilization), the price indices of medical services, and the price indices of pharmaceuticals during that time period.


Descriptive analyses showed that TPE and THE grew consistently during the years 1990–2009. The ratio of the THE/GDP increased more rapidly in recent years than the TPE/GDP. Furthermore, outpatient pharmaceutical expenditures (PEs) per visit and hospital PEs per admission grew throughout the study period. The amount of outpatient visits did not show a significant growth pattern during the 1990s, despite rapid GDP growth during that period. The time-series models showed that the TPE/THE was negatively associated with GDP during the same year (p = 0.039), as well as the medical consumer price index [CPI] (p = 0.021). The TPE/GDP was influenced by the price index of prescriptions (p < 0.001) and the amount of health services utilization, including inpatient admissions (p = 0.012) and outpatient visits (p = 0.003).


The cost escalations in PEs and health expenditures were concurrent with GDP growth. TPE has been the major source of financial burden for patients. Even though the rapid growth in China’s economy may ameliorate the overall TPE burden, control of PEs is still a key for successful health system reform.


Gross Domestic Product Health Care Utilization Outpatient Visit Gross Domestic Product Growth Pharmaceutical Expenditure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



All authors have contributed to the development of this manuscript. Specifically, Drs. Lizheng Shi and Qingyue Meng conceptualized the study design and analysis plan. Dr. Lizheng Shi developed the study protocol with Dr. Meng’s input. Dr. Gang Cheng collected the data for analysis. Heidi Y. Yang performed all data analyses. All authors participated in interpretation of results and the poster presentation at the International Society for Pharmacoeconomics and Outcomes Research Asia-Pacific Conference in Taipei, 2012. This study was partly supported by the China Medical Board-funded CCHDS visiting professorship for Dr. Lizheng Shi.Conflicts of interest The authors, including Dr. Lizheng Shi, Dr. Qingyue Meng, Dr. Gang Cheng and Heidi Y. Yang, have no conflicts of interest to declare that are directly relevant to the contents of this manuscript.


  1. 1.
    Sun Q, Santoro MA, Meng Q, Liu C, Eggleston K. Pharmaceutical policy in China. Health Aff. 2008;27(4):1042–50.CrossRefGoogle Scholar
  2. 2.
    Macilwain C. Handle with care. Nature. 2006;440(7087):990–1.PubMedCrossRefGoogle Scholar
  3. 3.
    Bloom G. Building institutions for an effective health system: lessons from China’s experience with rural health reform. Soc Sci Med. 2011;72(8):1302–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Zhang H. China’s irrational medical pricing scheme. Lancet. 2010;375(9716):726.PubMedCrossRefGoogle Scholar
  5. 5.
    Dong L, Yan H, Wang D. Drug prescribing indicators in village health clinics across 10 provinces of Western China. Fam Pract. 2011;28(1):63–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Yu X, Li C, Shi Y, Yu M. Pharmaceutical supply chain in China: current issues and implications for health system reform. Health Policy. 2010;97(1):8–15.PubMedCrossRefGoogle Scholar
  7. 7.
    Xu J, Yang Y. Traditional Chinese medicine in the Chinese health care system. Health Policy. 2009;90(2–3):133–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Chen W, Tang S, Sun J, Ross-Degnan D, Wagner A. Availability and use of essential medicines in China: manufacturing, supply, and prescribing in Shandong and Gansu provinces. BMC Health Serv Res. 2010;10(1):211.PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Meng Q, Cheng G, Silver L, Sun X, Rehnberg C, Tomson G. The impact of China’s retail drug price control policy on hospital expenditures: a case study in two Shandong hospitals. Health Policy Plan. 2005;20(3):185–96.PubMedCrossRefGoogle Scholar
  10. 10.
    Zhou B, Yang L, Sun Q, Gu H, Wang B. Social health insurance and drug spending among cancer inpatients in China. Health Aff. 2008;27(4):1020–7.CrossRefGoogle Scholar
  11. 11.
    Dong L, Yan H, Wang D. Antibiotic prescribing patterns in village health clinics across 10 provinces of Western China. J Antimicrob Chemother. 2008;62(2):410–5.PubMedCrossRefGoogle Scholar
  12. 12.
    Laurance J. A Chinese puzzle. Lancet. 2010;376(9755):1819.PubMedCrossRefGoogle Scholar
  13. 13.
    China National Health Development Research Center. China National Health Accounts Report 2010. Beijing; 2010.Google Scholar
  14. 14.
    Ministry of Health. China Health Statistics Year Book 2010. Beijing: Chinese Peking Union Medical College Press; 2010.Google Scholar
  15. 15.
    Prescription Drug Trends Fact Sheet—May 2010 update. (Accessed 27 April 2012).
  16. 16.
    You X, Kobayashi Y. Determinants of out-of-pocket health expenditure in China: analysis using China Health and Nutrition Survey data. Appl Health Econ Health Policy. 2011;9(1):39–49.PubMedCrossRefGoogle Scholar
  17. 17.
    Hu S. Universal coverage and health financing from China’s perspective. Bull World Health Organ. 2008;86(11):819.PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Hu S, Chen W, Cheng X, Chen K, Zhou H, Wang L. Pharmaceutical cost-containment policy: experiences in Shanghai, China. Health Policy Plan. 2001;16 Suppl 2:4–9.PubMedCrossRefGoogle Scholar
  19. 19.
  20. 20.
    Zhou Z, Su Y, Gao J, Xu L, Zhang Y. New estimates of elasticity of demand for healthcare in rural China. Health Policy. 2011;103(2–3):255–65.PubMedCrossRefGoogle Scholar
  21. 21.
    Hu S, Tang S, Liu Y, Zhao Y, Escobar M-L, de Ferranti D. Reform of how health care is paid for in China: challenges and opportunities. Lancet. 2008;372(9652):1846–53.PubMedCrossRefGoogle Scholar
  22. 22.
    Jiang H, Chen W, Bi K, Ying X. Are services delivered by community health centers more cost-effective? Evidence from urban China. Health Econ. 2009;18(S2):S107–17.PubMedCrossRefGoogle Scholar
  23. 23.
    Bhattacharjya AS, Sapra PK. Health insurance in China and India: segmented roles for public and private financing. Health Aff. 2008;27(4):1005–15.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2013

Authors and Affiliations

  • Lizheng Shi
    • 1
    • 2
  • Heidi Y. Yang
    • 2
  • Gang Cheng
    • 1
  • Qingyue Meng
    • 1
    Email author
  1. 1.China Center for Health Development StudiesPeking UniversityBeijingChina
  2. 2.School of Public Health and Tropical MedicineTulane UniversityNew OrleansUSA

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