National Essential Medicines List and policy practice: a case study of China's health care reform.

Background: In 2009, China implemented the national essential medicines system by enacting the National Essential Medicines List 2009. According to the policy of this system, primary health care institutions can only stock and use essential medicines on the prescribed List. Meanwhile, each province can choose to make its own list of supplemented medicines. The goal of the study is to provide suggestions for emerging problems and identify future policy-making trends.

Methods: In this study, we statistically analyzed the National Essential Medicines List 2009 and lists of supplemented medicines of all 29 provinces. We also examined the rationality of such medicines based on the DELPHI method and literature review, after which we studied the provincial supplements in relation to the national essential medicines system.

Results: We demonstrated that the National Essential Medicines List 2009 provides a comprehensive coverage of diseases as well as reasonable varieties of drugs for their treatment. The average number of supplemented medicines in 29 provinces is 207, with each medicine included in 2.9 provincial lists on average. Only 2.6% supplemented medicines are included by more than half of the provinces (>15), indicating great regional variance. Among the 32 most frequently supplemented medicines, only 18 meet the selection principles, including two with strict usage restrictions.

Conclusion: The structure and selection of the National Essential Medicines List 2009 are relatively reasonable. The main problems, however, include the excessive and non-scientific selection of medicines on the supplemented medicines list. The function of the provincial lists of supplemented medicines has not been achieved, which has influenced the effectiveness of the national essential medicines system in China.