From Price Governance to Spatial Equity: A Study on the Spatial Equity Effects of Volume-Based Procurement for Coronary Stents in China

From Price Governance to Spatial Equity: A Study on the Spatial Equity Effects of Volume-Based Procurement for Coronary Stents in China | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article From Price Governance to Spatial Equity: A Study on the Spatial Equity Effects of Volume-Based Procurement for Coronary Stents in China Yongyi Wu, Yijun Liu, Siyu Liu, Qiyun Zhu, Yongqi Li, Bin Jiang, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9302043/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract 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. Volume-based Procurement Coronary Stent Spatial Equity Equity in Resource Allocation Theil Index Full Text Additional Declarations No competing interests reported. Supplementary Files SupplementaryMaterials.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 13 Apr, 2026 Reviewers invited by journal 08 Apr, 2026 Editor invited by journal 06 Apr, 2026 Editor assigned by journal 05 Apr, 2026 Submission checks completed at journal 05 Apr, 2026 First submitted to journal 02 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9302043","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":623489089,"identity":"a2e76b6b-c7ca-429a-a4ff-8ec7aab1fa7a","order_by":0,"name":"Yongyi Wu","email":"","orcid":"","institution":"Peking University First Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yongyi","middleName":"","lastName":"Wu","suffix":""},{"id":623489090,"identity":"b2909e68-95c5-4656-8b30-a98864ca554d","order_by":1,"name":"Yijun Liu","email":"","orcid":"","institution":"Peking 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elucidate the underlying structural evolution of inequality patterns.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e 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.\u003c/p\u003e","manuscriptTitle":"From Price Governance to Spatial Equity: A Study on the Spatial Equity Effects of Volume-Based Procurement for Coronary Stents in China","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-16 03:07:13","doi":"10.21203/rs.3.rs-9302043/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"247570062554760468572115323973675892583","date":"2026-04-13T14:38:35+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-08T14:05:28+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-06T06:15:34+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-05T22:51:33+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-05T22:51:06+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2026-04-02T10:30:42+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ee3f2b0b-59aa-4659-800a-a2ca1e7850be","owner":[],"postedDate":"April 16th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-16T03:07:13+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-16 03:07:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9302043","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9302043","identity":"rs-9302043","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}