Key result
National volume-based procurement is linked to a ~59-fold increase in coronary stent affordability.
Why the study?
High medical device costs and geographic disparities in healthcare resources have constrained equitable access to PCI in China. This study systematically evaluated the impact of the national volume-based procurement policy for coronary stents on spatial equity and inequality patterns.
Does the national volume-based procurement (VBP) policy for coronary stents improve per capita stent affordability and spatial equity of resource allocation across healthcare institutions in China?
Observational (n=2,261)
Yes
Does the national volume-based procurement (VBP) policy for coronary stents improve per capita stent affordability and spatial equity of resource allocation across healthcare institutions in China?
China's national volume-based procurement policy reduced winning coronary stent prices by over 90%, increased per capita affordability by 58.73-fold, and shifted allocation inequality from macro-level inter-regional disparities to micro-level intra-provincial disparities.
Answers are grounded in this paper and cite their sources.
VBP may improve stent affordability and spatial equity in China; leaves open generalizability to outcomes and other systems.
Background: For decades, the high cost of medical devices and the geographic stickiness of high-quality healthcare resources have substantially constrained equitable access to percutaneous coronary intervention (PCI) among patients with coronary heart disease in China. Objective: This study aims to systematically evaluate the profound impact of the national volume-based procurement (VBP) policy for coronary stents on the spatial equity of high-value medical consumables, and to elucidate the underlying structural evolution of inequality patterns. Methods: A retrospective longitudinal design was employed. Procurement data on coronary stents were collected from 2,261 healthcare institutions across 31 provinces in China for 2019 (pre-VBP) and 2021 (post-VBP). Key indicators included per capita affordability of stents and procurement volume. Inequality and spatial distribution were assessed using the Gini coefficient, Theil index decomposition, and spatial autocorrelation analysis, including Global Moran’s I and Local Indicators of Spatial Association (LISA), to examine regional disparities and spatial clustering patterns. Results: Following the implementation of VBP, the average price of winning stents declined by more than 90%, while per capita affordability increased by 58.73-fold. The proportion of high-quality alloy stents surged from 65.76% to 98.59%. Theil index decomposition revealed a structural reversal in the drivers of inequality: the dominant source shifted from inter-regional (macro-level) disparities in 2019 to intra-provincial (micro-level) disparities in 2021. Spatial autocorrelation analysis further showed that Moran’s I decreased from 0.2996 to 0.1440, indicating a substantial disruption of the previously pronounced macro-level geographic clustering. Conclusions: The VBP policy significantly improved the accessibility of coronary stents and facilitated an upgrade in the quality of clinical consumables. More importantly, it induced a structural shift in the drivers of inequality in healthcare resource allocation in China—from macro-level regional disparities to intra-provincial micro-level disparities.
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Wu et al. (2026) conducted an observational in Coronary artery disease requiring percutaneous coronary intervention with coronary stents (n=2,261). National Volume-Based Procurement (VBP) policy for coronary stents vs. Pre-VBP period (2019) was evaluated on Per capita affordability of coronary stents (annual disposable income per capita divided by unit price of stent) (58.73-fold increase). National volume-based procurement reduced winning coronary stent prices by 91.70%, increased per capita affordability 58.73-fold, and decreased spatial clustering.
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