Essential Drug System Research Articles

Curative care expenditure of outpatient anxiety disorder in Liaoning Province, 2015-2020-based on "System of Health Accounts 2011".

Anxiety disorders are the most common mental disorder, experienced by more than a quarter of the population. This study examines total outpatient curative care expenditures (CCE) for anxiety disorders and changes in their composition based on the System of Health Accounts 2011 (SHA 2011). This study used multi-stage stratified random from a total of 9,318,513 outpatient sample data by 920 healthcare organizations, a total of 109,703 cases of anxiety disorders from 53 sample organizations (5.76%) from 2015 to 2020. Univariate analysis, multifactor analysis and structural equation modeling (SEM) were used to explore the influential factors affecting outpatient CCE for anxiety disorders. Anxiety disorder outpatient CCE from 2015 to 2020 continued to increase from CNY 99.39million in 2015 to CNY 233.84 million in 2020, mainly concentrated in western medicine costs, 15-64 years, general hospital, generalized anxiety disorder and public financing. The results of univariate analysis showed statistically significant differences in all subgroups, and the results of multivariate analysis and SEM showed that the choice to purchase western drugs, purchase prepared Chinese drugs, choice to have a checkup, urban employees' basic medical insurance, and 0-14 years old were associated with high anxiety disorder outpatient CCE. Initiatives to improve the essential drug system, reduce the out-of-pocket (OOP) ratio, and strengthen primary health care to effectively reduce the medical burden on patients.

Survey and analysis of the availability and affordability of essential drugs in Hefei based on WHO / HAI standard survey methods

BackgroundThe 2018 edition of the National Essential drugs List came into effect in September 2018. Relevant policies require that all primary medical and health institutions should supply national essential drugs, while secondary and tertiary medical and health institutions should supply a certain percentage of essential drugs.MethodsOur research used the standard methods of WHO and HAI, selected 50 basic drugs, combined with the actual situation of Hefei City, selected 30 medical institutions and 30 pharmacies, conducted drug availability and affordability studies.ResultsThe availability of the lowest-price generics (LPGs) of essential drug in Hefei is much higher than that of the Originator brands (OBs); the overall affordability is better, but there is a large gap between the affordability levels of OBs and LPGs. OBs are relatively poorly affordable.ConclusionThe implementation of the national essential drug system in Hefei has achieved certain results, but there is still a gap from the expected target. It is recommended to update and adjust the list of essential drugs in accordance with the demand for clinical medicines, ensure that medical and health institutions at all levels supply essential drugs, popularize knowledge of essential drugs, and moderately adjust the price of OBs to reduce the medication burden.

PIH16 - Analysis of Patients' Satisfaction on the Implementation of Essential Drug System in China

PIH16 - Analysis of Patients' Satisfaction on the Implementation of Essential Drug System in China

Research on application status of Chinese herbal decoction pieces based on clinical survey

Chinese herbal decoction pieces are the basic approaches for clinical traditional Chinese medicine (TCM), reflecting the features and advantages of TCM. In order to investigate the clinical application status and features of Chinese herbal decoction pieces, the questionnaire on application of commonly used Chinese herbal decoction pieces was designed in this study for analysis of the application situations of Chinese herbal decoction pieces from 56 medical institutions in 10 provinces. The results showed 549 varieties of Chinese herbs and 801 varieties of decoction pieces were used on clinic. They can be classified into 19 categories according to their effects. The varieties of Gancao (Glycyrrhizae Radix et Rhizoma), Huangqi (Astragali Radix), Dihuang (Rehmanniae Radix), Chuanxiong (Chuanxiong Rhizoma), Baizhu (Atractylodis Macrocephale Rhizima), Huangqin (Scutellariae Radix), Danggui (Angelicae Sinenses Radix), Baishao (Paeoniae Radix Alba) and Maidong (Ophiopogonis Radix) were most common ones; the application of Chinese herbal decoction pieces from different medical institutions was differentiated from areas to areas. The survey results reflected the general situation about application of decoction pieces, providing the basic data for recording and completing Chinese herbal decoction pieces in essential drug system, with certain reference significance for the production of Chinese medicinal materials and the allocation of the varieties of Chinese herbal decoction pieces.

Mapping and Analyzing Stakeholders in China’s Essential Drug System by Using a Circular Model: Who We Should Deal with Next?

ObjectivesTo predict the prospects of the essential drug system by using the Stakeholder Impact Index (SII) and evaluate the current performance of each main stakeholder and suggested dangerous stakeholders and dormant stakeholders. MethodsA Delphi method was used, involving 36 experts with experience in implementation and evaluation of the essential drug policy, to construct the circular model as well as evaluate the performance of each stakeholder. ResultsThe central government was a dominant stakeholder of the whole essential drug system. The provincial governments were definitive stakeholders, whereas local governments and medical institutions were dependent stakeholders. Furthermore, media and drug stores were dormant stakeholders and pharmaceutical manufacturers and delivery enterprises were dangerous stakeholders. Patients, community residents, and medical insurance programs were discretionary stakeholders. The SII for the essential drug system was positive (SIIproj⁎ = 2.72). ConclusionsThe overall anticipation of the essential drug policy is optimistic. Letting definitive stakeholders (provincial governments) having more autonomy can efficiently accelerate the pace of implementation of the essential drug policy in the current situation. Central government, however, also needs to construct an experience exchange platform with the aim of building versatile methods for running the essential drug system in all provinces. Pharmaceutical manufacturers and delivery enterprises were dangerous stakeholders for the essential drug policy. Because of their potential threat to the implementation of the policy, the central government should motivate them to support the construction of the essential drug system spontaneously. In that case, provincial governments need to construct a fair, balanced, and self-stabilized bidding platform.

An Evaluation on Equity in Current Primary Healthcare Reform in China

The objective of the article is to assess equity in recent primary healthcare reform in China. Through a careful examination of the current efforts in promoting equity in access to basic healthcare services between urban and rural populations, we aim to identify problems and provide specific suggestions. The method we used was based on literature review and government reports, as well as case studies of healthcare reform in Hunan province; this article adopts the methods of empirical evaluation combined with normative analysis and interpretation. We have found that the government’s efforts to promote equity in economic and geographical accessibility are currently far from sufficient. The coverage and degree of benefit of basic medical insurance has been improved, yet a big gap still exists among different groups. Grassroots health providers are urgently in need of capability and efficiency building in delivering services. We conclude that the basic medical insurance system should be strengthened in order to narrow the gap between rural and urban residents, and urban employees in particular. Health insurance subsidies and reimbursement rates for rural residents should be further increased. The essential drug system also needs to be improved to ensure openness and transparency.

Drug Access Is Improved By The Essential Drug System And "Low-Priced Drug" Policy In China.

(1) Since 2009 China had implemented national essential drug system, and issued first and second edition of NEDL (National Essential Drugs List) respectively in 2009 and 2013, which respectively covered 307 drugs and 520 drugs. (2) With development of Chinese health care reform, planning low-priced drug policy and adjusted essential drug system will impact on drug access. To describe Chinese policies’ development for promoting drug access, analyze the policies’ impact and potential lacks. Through collecting relevant policies from national departments and 31 provinces, apply descriptive statistics and comparison to summarize these policies’ impact. (1) On May 2013 China NHFPC had released the second edition of NEDL, which increased to 520 drugs and allowed all provinces to implement after appropriate addition. Until the end of February 2014, nine provinces in China had supplemented average 251 drugs (average 121 western medicines and 130 TCM) on the basis of 520 drugs. The most was 535 in Xinjiang and the least is 57 in Gansu. (2) Meanwhile, China NDRC was planning to introduce low-priced drug list covering 890 drugs, the price control of which will be released if average daily cost is less than 3 RMB for western drugs or 5 RMB for TCM. (3) On February 27,2014 Guangdong province had released “low-priced drugs list of non-essential drugs” including 1103 drugs, then plus essential drugs in the province, relatively cheap drugs that patients could afford are theoretically up to 1902. (1) These two policies had provided quantitatively safeguard for patients access to relatively cheap drugs close to 2,000. (2) Chinese “parallel development” policy for TCM and Western Medicine will be insisted on for a long term. (3) It needs more scientific mechanism designed to avoid the lacks of“double envelop”tendering and distortion of doctors’ income.

The Impact on Drug Price and Patiet Selection of National Essential Drug System: Evidence From Inpatient Records from Insurance Reimbursement Data.

The Impact on Drug Price and Patiet Selection of National Essential Drug System: Evidence From Inpatient Records from Insurance Reimbursement Data.

Cognition and evaluation of the essential drug system by doctors at township health centers of different ownership systems

Objective To understand the comments for the essential drug system by doctors at township health centers in Nantong's six counties and to discuss the effect of implementing the essential drug system to different ownership systems.Methods The survey was made with stratified clusters random sampling method to select township health centers.Questionnaires were filled out by doctors,and leaders of the health bureau and township health centers were interviewed.Results After the implementation of the essential drug system,94.6％of the doctors found that the number of laboratory examinations increased in Rugao,Rudong and Haian.23.2％of the doctors in Tongzhou,Qidong and Haimen found that enthusiasm for work increased.Conclusion The compensation mechanism should be perfected and the financial subsidies should be paid in time.Supervision and management should be strengthened and the grassroots need for medicine be ensured.The skills training should be enhanced and the medical service ability be improved. Key words: Essential drug system; Ownership system; Township health centers; Doctors; Evaluation

Performance evaluation indicator system for the implementation of essential drug system in community health service institutions

<h3>Objective</h3> This research aims to develop a more scientific and reasonable performance evaluation indicator system for the implementation of an essential drug system in community health service institutions. <h3>Methods</h3> The Delphi method was used to establish an indicator system based on three rounds of expert consultations, and the fuzzy comprehensive evaluation method was used to determine the weights of the indicators. <h3>Results</h3> The participation in the three rounds of consultations were 100% (10/10), 90% (18/20), and 85% (17/20), which showed that the experts had real enthusiasm for participating in this research. The authority coefficients of the first-, second-, and third-level indicators were 0.75, 0.76, and 0.76, respectively, which showed that the consultation results were dependable. The concordance coefficients of the second and third rounds were 0.489 and 0.487, respectively (<i>P</i> &lt;0.001), indicating that the expert opinions were highly consistent. The performance evaluation indicator system consisted of three first-level indicators (supporting, implementation, and effect indicators), nine second-level indicators, and 21 third-level indicators. <h3>Conclusion</h3> In this new performance evaluation indicator system, the selected experts were representative, the consultation results were dependable, the constructed evaluation indicator system was reasonable, and the setting of weights was scientific.

Investigation of implementation of essential drug system in 23 secondary hospitals in southern part of Sichuan Province

Objective:To investigate the implementation of essential drug system in secondary hospitals in southern part of Sichuan Province,so as to provide reference for optimizing the list of essential drugs.Methods:Twenty three secondary hospitals in this area were selected as samples.The categories of essential drugs and their constituent ratios in categories of all of the drugs,consumption sum of essential drugs and its constituent ratio in the consumption sum of all of the drugs were calculated and analyzed.Results:The constituent ratios of categories of essential drugs were 25.67%,32.21% and 35.58%,and constituent ratios of consumption sum were 22.82%,27.71% and 31.24%in class A secondary hospitals during 2009-2011.The constituent ratios of categories of essential drugs were 32.13%,36.08% and 40.91%,and constituent ratios of consumption sum were 26.82%,31.96% and 36.53% in class B secondary hospitals.Conclusion:The implementation of essential drug system in southern part of Sichuan Province generally met the requirements.Secondary hospitals should conscientiously implement the national essential drug system,and increase the constituent ratio and consumption amount of essential drugs.

Advances in research on perfecting National Essential Drug System

To consolidate and improve National Essential Drug System is one of the key issues in the new round of medical and health system reform.Through retrieval of relevant literature in recent years,the paper made a comprehensive review of the main mode,social recognition as well as major difficulties,challenges and policy orientation,since the new round of medical and health system reform.

Comprehensive reform of community health service in east, middle and west regions of China: from patients’ perspective

<h3>Objectives</h3> To analyze the satisfaction of patients with community health service (CHS) and the changes of the CHS delivered before and after the new health reform in different regions of China, and to put forward relevant policy recommendations for CHS development. <h3>Methods</h3> Twelve community health centers were selected by random sampling in each of the eight typical cities in the east, middle and west regions of China. Questionnaire survey was conducted among patients visiting these institutions during daily work hours. <h3>Results</h3> The proportions of the participants who stated that the medical environment, service attitude and medical skills of the doctors were improved were higher in the west region than those of the east and middle regions; but the percentage of patients who held that the drug price had lowered was higher in the east region than those of the middle and west region, the differences were of statistical significance (<i>P</i>&lt;0.0125). The patients’ satisfaction rates with medical environment, service attitude, and technical skills of the medical staff in the west region were 88.9%, 91.5% and 81.6% respectively, which were higher than those in the east and middle regions. In the east region, the satisfaction rate with the reimbursement for this visit was 58.5%, which was highest among the three regions; in the west region, patients’ satisfaction rates with drug types and preventive care were 51.5% and 65.9%, respectively, which was significantly higher than those in the east and middle regions (<i>P</i>&lt;0.0125). As recommended by the participants, the top three aspects of health services that need to be improved were drug type and quality (25.3%), drug prices (21.8%) and technical skills (18.2%) in the east region; infrastructure (28.2%), drug prices (21.8%) and drug types and quality (21.2%) in the middle region; infrastructure (30.8%), drug types and quality (28.1%) and reimbursement (27.9%) in the west region. <h3>Conclusions</h3> The comprehensive CHS reform should take the opinions of patients into account; essential drug system should be consolidated continually; and the reform of the payment system should be promoted by actively cooperating with the health insurance organizations.

PRM90 - Mapping and analyzing stakeholders in china's essential drug operation system by using circular model: Who we should deal with next?

To classify each of the stakeholders in National Essential Drug System(NEDS) in China by three major attributes: power, legitimacy and urgency. To predict the outcome of the whole system by using the Stakeholder Impact Index (SII). To evaluate the current performances of each main stakeholder and identify definitive stakeholders and dangerous stakeholders. To develope a circular model for NEDS based on indexes collected by Delphi method. A circular model has been developed to map all major stakeholders in the NEDS using quantitative data collected by Delphi method involving 36 experts with experience in implementation of essential drug policy were interviewed. The central government in the circular model for essential drug system was a dominant stakeholder of the whole stakeholder system. The provincial governments were definitive stakeholders while local governments and medical institutions were dependent stakeholders. Furthermore, media and drug stores were dormant stakeholders, pharmaceutical manufacturers and distribution enterprises were dangerous stakeholders. Patients, community residents and medical insurance programs were discretionary stakeholders. The Stakeholder Impact Index for the NEDS was positive (SIIproj = 2.72). Our finding indicates that the overall anticipation of national essential drug policy is optimistic. Provincial governments, which should be in the position of leading the implementation of essential drug policy, need to be given more autonomy and the constrcution of an experience exchanging platform within provinces in the form of annual symposium, seasonal meeting, learning class or video conferences may accelerate the pace of implementation of national essential drug policy. Pharmaceutical manufacturers and distribution enterprises should be taken more seriously care of in order to make sure they follow the policy rather than devastate it for their own benefits. Constructing a fare, balanced and self-sustained bidding platform may be the key solution for preventing such a phenomenon.

Experiments made for zero inventory control of essential drugs at public hospitals in Yuhuan county

The paper covered main practices made at public medical institutions in Yuhuan county,Zhejiang province in promoting zero inventory control of essential drugs.The experiments include better mechanism,building informationized settlement system of the entire drug flow,centralized drug purchase,as well as smart supply chain terminal execution system,and third-party payment.The zero inventory control has effectively cut back drug distribution.costs and achieved the all-win outcome of medical institutions and drug suppliers. Key words: Essential drug system; Primary healthcare institutions; Zero inventory; Drug distribution

Analysis and recommendations on sustainable development of the essential drug system at secondary hospitals

This paper made systematic description of the three objectives of sustainable development designed for the policy based on the sustainability theory for the health sector.The essential drug system for secondary hospitals comprises the list coverage and allocation percentage of essential drugs,requirements for bidding and purchasing as well as pricing practice; management and conditions of these hospitals,including leadership determination and competency,doctors prescription behavior,and supportive reforms at these hospitals; external policies and social environment,including government financial subsidy,medical service prices adjustment,medical insurance,and the awareness and attitude of the people on essential drugs. Key words: Essential drug system; Secondary hospitals; Sustainability

On residents’ satisfaction with community health services after health care system reform in Shanghai, China, 2011

BackgroundHealth care system reform is a major issue in many countries and therefore how to evaluate the effects of changes is incredibly important. This study measured residents’ satisfaction with community health care service in Shanghai, China, and aimed to evaluate the effect of recent health care system reform.MethodsFace-to-face interviews were performed with a stratified random sample of 2212 residents of the Shanghai residents using structured questionnaires. In addition, 972 valid responses were retrieved from internet contact. Controlling for sex, age, income and education, the study used logistic regression modeling to analyze factors associated with satisfaction and to explain the factors that affect the residents’ satisfaction.ResultsComparing current attitudes with those held at the initial implementation of the reform in this investigation, four dimensions of health care were analyzed: 1) the health insurance system; 2) essential drugs; 3) basic clinical services; and 4) public health services. Satisfaction across all dimensions improved since the reform was initiated, but differences of satisfaction level were found among most dimensions and groups. Residents currently expressed greater satisfaction with clinical service (average score=3.79, with 5 being most satisfied) and the public health/preventive services (average score=3.62); but less satisfied with the provision of essential drugs (average score=3.20) and health insurance schemes (average score=3.23). The disadvantaged groups (the elderly, the retired, those with only an elementary education, those with lower incomes) had overall poorer satisfaction levels on these four aspects of health care (P<0.01). 25.39% of the respondents thought that their financial burden had increased and 38.49% thought that drugs had become more expensive.ConclusionThe respondents showed more satisfaction with the clinical services (average score=3.79) and public health services/interventions (average score=3.79); and less satisfaction with the health insurance system (average score=3.23) and the essential drug system (average score=3.20). Disadvantaged groups showed lower satisfaction levels overall relative to non-disadvantaged groups.

On the trials of essential drug system in Dongtai county, Jiangsu province

The paper introduced the trials and experiences acquired in carrying out the essential drug system in Dongtai city, Jiangsu province, probing into specific practices of improving such a system and deepening the medical and healthcare reform. Practices prove as advocated by the author that the building and betterment of an essential drug system characterized of Zero price margin in unified bidding, procurement and distribution. Such a system can not only alleviate the financial burden of diseases of the people, but also enhance clinical drug use safety, encourage rational use of healthcare resources, and promote patient satisfaction in the end. Key words: Medical and healthcare system reform; Essential drug system Probe