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

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.