Impact of shifting blood donation policy from gift to honour model: staggered difference-in-differences analysis in China.

OBJECTIVE: To evaluate the impact of a new blood donation incentive policy-an honour model promoting blood donation quality and quantity to inform future policy changes in China and worldwide. DESIGN: Staggered difference-in-differences analysis in China. SETTING: Blood donation policies (from provincial government official websites), annual blood donation data (from China's reports on blood safety and annual reports on development of China's blood collection and supply industry), and demographic and socioeconomic indicators (from China city statistical yearbooks and provincial statistical yearbooks) from 2012 to 2018. POPULATION: Blood stations from 30 provinces of China; four regions excluded because data not available. INTERVENTION: The honour model (social recognition through an honour card granting frequent blood donors honorary incentives such as free access to public bus services and outpatient consultations in hospitals) was piloted to stimulate blood donations in intervention provinces. MAIN OUTCOME MEASURE: Annual total count of blood donations and total count of whole blood donations to measure the quantity of blood donations, and annual donor eligibility rate to measure the quality of blood donations. RESULTS: The honour model increased blood donation counts by 3.55% (95% confidence interval 1.30% to 5.80%, P=0.003) by the end of the second year of implementation. By the end of the fifth year, this effect had doubled to 7.70% (2.42% to 12.98%, P=0.006). Most of these increases were driven by absolute increases in whole blood donation of 3.34% (1.11% to 5.56%, P=0.005) and 7.23% (1.90% to 12.56%, P=0.01) by the end of the second and fifth years, respectively. The honour model did not significantly affect the donor eligibility rate. The Borusyak-Jaravel-Spiess difference-in-differences analysis, synthetic difference-in-differences analysis, and placebo test all suggested the results were robust. CONCLUSIONS: The honour model of blood donation increased the quantity of blood donation in China, while donation quality remained unchanged. This impact was sustained after the introduction of the honour model within the study period.