Data sources and outcome indicators

According to Guangdong province’s geographical divisions, it can be divided into 4 regions of East Guangdong, West Guangdong, North Guangdong, and Pearl River Delta. Thus, we adopted the purposive sampling method to investigate eight county-hospitals from four regions respectively, which also represent the level of economic development in Guangdong province. Given the lag in policy implementation, we choose the time when the policy was fully implemented as the intervention point. Therefore, August 2015 and December 2018 are the intervention measure of ZMD policy and the intervention measure of ZMC policy, respectively.

Monthly data from January 2013 to August 2019 were collected, which covers the total number of outpatients, number of inpatients, and total service revenue in both outpatients and inpatients. The total service revenue also includes drug revenue, consumable revenue, inspection revenue (assay revenue), medical service revenue, and others. We define medical service revenue as the income from providing technical services, such as treatment, surgery, and nursing. These services involve the rich experience, high skill, and heavy labor of medical personnel. All of the data are converted to real terms based on the Consumer Price Index for Medical Services in Guangdong province.

Given the objective of medical pricing reforms, indicators on hospital revenue and healthcare expenditure in both outpatients and inpatients are designed and calculated. The indicators are the proportion of the major component revenue in total revenue, total expenditure per capita for outpatient and inpatient, and its major components, such as the drug expense per capita for outpatient. In this study, the sample ranges from 2013 to 2019, with 80 observations in total.