基層衛生醫療機構基本藥物政策實施效果研究

Background： Providing safe, necessary, effective and affordable essential medicines for people is an important measure to control medicines costs, to reduce the economic burden of disease, to meet primary medicines needs, to ensure the health fair as well, and is an effective way to achieve health care access for all with finite funds and resources. In recent years, the problem of inadequate and unaffordable medical services has become increasingly prominent in China, and seriously impacted on the construction of a harmonious socialist society, especially the drugs-maintaining-medicine mechanism in public health institutions, attached great importance with the community and the government. Since 2006, the government began to plan a new round of health care reform, and explore ways to establish Essential Medicines System (EMS). April 6, 2009, the new health care reform program was unveiled, August 18 in the same year, the EMS was officially launched, and primary health institutions began testing the pilot implementation of the policy. Purpose： Drawing ideas form international essential medicines policy development and implementation experience. To evaluate the implement effect of the EMS from process of manufacture, distribution and use etc. with the new health reform context. To give some advice to the government to ensure the effective implementation of the national essential medicines policy, and to promote primary health care in China, with theoretical, political and empirical basis. Objectives： 1、To evaluate implementation effect of the new policy measures to the price control of essential medicines in primary health institutions. 2、T o analyze the changes in the number of medicines in outpatient prescription in primary health institution and evaluate the status of the rational medicine use; 3、To evaluate the availability of essential medicines in primary health institutions Methods: Guided by the theory of the essential medicines, through the literatures review, using the second-hand data form National Development and Reform Commission of mid-term pre-assessment of implementation of the new health reform in Zhejiang Province, an empirical case about distribution conditions, sales and price changes (compare Laspeyres index with Paasche index) of essential medicines, and the use of outpatient prescriptions（the number of medicines in single prescription and its frequency distribution）, from 99 primary health care institutions in Zhejiang Province, was quantitatively analyzed, and the differences of national essential medicines and provincial added essential medicines were compared. Microsoft Excel 2003 and SPSS 16.0 were used for statistical analysis. Results: (1)The retail prices of essential medicines in sample primary health institutions decreased by 33.62% on average, Laspeyres index 62.42% was greater than Paasche index 61.70% of retail price in samples primary health institutions, which showed that the essential medicines which had got a large decline in retail prices had got a large increasing in use volume: the use volume of the medicines whose price decreased by more than 40% increased by 233.13% on average; the use volume of the medicines whose price decreased by between 20%-40% increased by 146.68% on average; the use volume of the medicines whose price decreased by less than 20% (including some individual medicines whose price increased)increased by 122.12% on average. (2) The number of all medicines in a single out-patient prescription declined 0.28 on average, the number of the national essential medicines increased by 0.5 on average, the number of antibiotics decreased by 0.05 on average, the number of injection deceased by 0.2 on average, the rate of infusion using deceased by 1.35% on average, and the rate of steroid using deceased by 2.63% on average in samples primary health institutions. (3) 1/3 sample primary health institutions have achieved the policy goal of using national essential medicines and provincial added essential medicines only, the species of essential medicines accounted for 82.47% on average of the species of all medicines in other primary health institutions, the lowest one was only 41.19%. The species of essential medicines accounted for 61.27% on average of the species of all essential medicines in lists in all of these primary health institutions. (4) Sample primary health institutions had got timely delivery rates 96.45% in frequency and 96.44% in sum. Conclusions: The EMS has been implemented for more than a year, with some problems but more effects: (1) Zero mark-up policy and other price control measures effectively reduced the medicines prices in primary health institutions; as well the use of essential medicines has been promoted. This was also the most prominent effect of the implementation of EMS. (2) The use of out-patient prescription in primary health institutions became more reasonable and rational, the "big prescription", the abuse of antibiotics and steroid, and excessive use of injections and infusion has been getting less. (3) The availability of essential medicines in primary health institutions was not bad. Most pilot primary health institutions have not achieved the policy goal of using national essential medicines and provincial added essential medicines only. A number of essential medicines have not been used in primary health institutions, while some out-list medicines was still in use. In circulation of essential medicines, the measures of centralized procurement and distribution was high efficient to ensure the supply of essential medicines in primary health institutions, and there was no apparent shortage. Policy implications: The government should strengthen its responsibility to primary health and safeguard social fairness and justice. More specifically, the government should uphold and improve the measures of centralized procurement and distribution of essential medicines, zero mark-up policy and other policy measures; timely adjust the essential medicines list; increase financial input and optimize indemnity mechanism; promote the rational use of medicines by further normalizing the behaviors of medical institutions and medical personnel with implementation of Standard Therapeutic Guidelines and National Formulary; co-ordinate other supporting policies and measures.

University of Macau

Institute of Chinese Medical Sciences