National Essential Medicines Policy Research Articles

PNS22 Hospital Ownership and National Essential Medicines Policy: A Comparative Study between the Public and Private Primary Health-Care Institutions in Nantong, China

PNS22 Hospital Ownership and National Essential Medicines Policy: A Comparative Study between the Public and Private Primary Health-Care Institutions in Nantong, China

Patients' Coping Behaviors to Unavailability of Essential Medicines in Primary Care in Developed Urban China.

Background: China rolled out the national essential medicines policy (NEMP) in primary care in 2009 and led to some unintended consequences including unavailability of essential medicines. This study examined patients’ coping behaviors to these unintended consequences of NEMP as well as the potential impact on primary care system development in Hangzhou, a developed city of China. Methods: We conducted qualitative interviews and surveys with service users, primary care physicians (PCPs), and specialists in tertiary hospitals. Qualitative findings informed the design of the survey questionnaires. Main outcomes included patients’ coping behaviors after the NEMP implementation, as well as providers’ perceptions of NEMP’s impact on primary care development. Thematic analysis of the qualitative data and descriptive analysis of the survey data were conducted. Results: Unintended effects of NEMP included frequent unavailability of certain essential drugs, leading to patient flow from primary care to hospital outpatient clinics for drug refills, difficulties in the provision of continuing care in primary care, as well as compromised patient trust in PCPs. In total, 1248 service users completed the questionnaires. A total of 132 (10.6%) were aged 60 years or above. Among 153 (57.7%) of the 265 who had some chronic condition(s) and needed long-term medication treatment, 60.1% went to hospitals for refills. Four-hundred sixty PCPs and 651 specialists were recruited. Among 404 PCPs who were aware of the NEMP policy implementation in their facility, 169 (41.8%) reported that there was often a shortage of drugs at their facilities and 44 (10.9%) reported always. Moreover, 68.6% of these PCPs thought that the NEMP could not meet their patients’ needs. Further, 44.2% (220/498) of specialists who were aware of the NEMP policy in primary care reported that they often heard patients complaining about the policy. In total, 53.1% of PCPs and 42.4% of specialists disagreed that NEMP helped direct patient flow to community-based care. Conclusion: NEMP’s unintended effects undermined patients’ utilization of primary care in a developed city in China and led to unnecessary hospital visits. Countermeasures are needed to mitigate the negative impacts of NEMP on the primary care system.

An analysis on rational use and affordability of medicine after the implementation of National Essential Medicines Policy and Zero Mark-up Policy in Hangzhou, China.

BackgroundThe National Essential Medicine Policy and the Zero Mark-up Policy was introduced to improve the rational use and affordability of medicine. This study analyzed the changes of medicine use at different Health Care Institutions in Hangzhou city after the implementation of National Essential Medicine Policy and the Zero Mark-up Policy.MethodsFacility based survey was conducted in 17 Health Care Institutions and 16406 outpatient prescriptions in 2011 and 2013 were collected. Average number of medicines, average number of antibiotics and average expenditure per prescription were analyzed. Comparisons between 2011 and 2013, among different levels of Health Care Institutions and age groups were conducted.ResultsThe average number of medicines per prescription, use of antibiotics, intramuscular (IM) injections and intravenous (IV) injections decreased while the use of hormones increased. No significant change of the average medicine expenditure per prescription was observed. Disparities among different levels of Health Care Institutions and different age groups existed.ConclusionThe problems of poly-pharmacy, overuse of antibiotics, intramuscular (IM) injections and intravenous (IV) injections and hormones still existed, however mitigated after the implementation of The National Essential Medicine Policy and the Zero Mark-up Policy.

A survey of availability, price and affordability of essential medicines from 2011 to 2016 in Chinese secondary and tertiary hospitals

BackgroundEssential medicines are those drugs that satisfy the priority health care needs of the population and help with functioning healthcare systems. Although many countries have formulated an essential medicine list, almost half of the global population still lack regular access to essential medicines. Research about the initiation of National Essential Medicines Policy in Chinese secondary and tertiary hospitals is inadequate, and the long-term effect on access after the reform is still unknown. This study’s objective was to investigate the access to essential medicines in mainland China’s secondary and tertiary hospitals.MethodsData on the access to 30 essential medicines from China’s National Essential Medicine List were obtained from China Medicine Economic Information database covering 396 secondary hospitals and 763 tertiary hospitals. We improved the standard methodology developed by the World Health Organization and the Health Action International to measure the availability, median price ratio (MPR) and the incidence of catastrophic drug expenditure (CDE).ResultsFive essential medicines had > 50% availability and the nationwide availability kept steady; availability of drugs in eastern regions of China was significantly higher than the central and western regions. The median MPR of 30 drugs nationwide kept steady approximately 5; MPR of drugs in the eastern regions was significantly higher than the central and western regions and the ratio of MPR of innovator brands to generics increased from 3.66 to 6.32 during the study period. The incidence of CDE caused by essential medicines decreased from 2011 to 2014; brand name medicines were more likely to cause CDE than generics and rural patients have a greater tendency to fall into CDE.ConclusionsAfter the implementation of National Essential Medicines Policy, the MPR of essential medicines was well controlled and became more affordable in the context of steady availability. This has highlighted the problems associated with region disparity and inequity between rural and urban areas in the delivery of essential medicines and sustainable mechanisms are needed to deepen the National Essential Medicines Policy in mainland China.

Patient satisfaction with prescribed medicines in community health services in China: A cross-sectional survey 6years after the implementation of the national essential medicines policy.

The National essential medicines policy (NEMP) is promoted by the World Health Organization for affordable medicines that can meet the basic needs of communities. Patient acceptance is essential for achieving the policy goals of the NEMP. This study aimed to assess patient satisfaction with prescribed medicines in community health services under the NEMP context in China. A stratified random sampling strategy was adopted to select 1,037 participants in 40 community health centres from four provinces in China. Patient satisfaction was rated on a five-point Likert scale (from 1="very dissatisfied" to 5="very satisfied") covering four domains: availability, affordability, effectiveness and safety. The results showed that the participants expressed a moderate degree of satisfaction, with a rating in the range of 66-82 out of a total of 100. Older people, those covered by insurance and those with a lower level of education tended to have higher ratings. While eastern (wealthy) residents were more likely to be concerned with "effectiveness," western (poor) residents were more likely to be concerned with "affordability." Awareness of the NEMP was negatively associated with patient satisfaction after control for other factors.

Perceived impacts of the national essential medicines system: a cross-sectional survey of health workers in urban community health services in China

ObjectivesThis study aimed to investigate the perceptions of primary care workers about the impacts of the national essential medicines policy (NEMP).SettingA cross-sectional questionnaire survey was undertaken in 42 urban community...

Organizational barriers associated with the implementation of national essential medicines policy: A cross-sectional study of township hospitals in China

This study identifies potential organizational barriers associated with the implementation of the Chinese National Essential Medicines Policy (NEMP) in rural primary health care institutions. We used a multistage sampling strategy to select 90 township hospitals from six provinces, two from each of eastern, middle, and western China. Data relating to eight core NEMP indicators and institutional characteristics were collected from January to September 2011, using a questionnaire. Prescription-associated indicators were calculated from 9000 outpatient prescriptions selected at random. We categorized the eight NEMP indicators using an exploratory factor analysis, and performed linear regressions to determine the association between the factor scores and institution-level characteristics. The results identified three main factors. Overall, low levels of expenditure of medicines (F1) and poor performance in rational use of medicines (F2) were evident. The availability of medicines (F3) varied significantly across both hospitals and regions. Factor scores had no significant relationship with hospital size (in terms of number of beds and health workers); however, they were associated with revenue and structure of the hospital, patient service load, and support for health workers. Regression analyses showed that public finance per health worker was negatively associated with the availability of medicines (p < 0.05), remuneration of prescribers was positively associated with higher performance in the rational use of medicines (p < 0.05), and drug sales were negatively associated with higher levels of drug expenditure (p < 0.01). In conclusion, irrational use of medicines remains a serious issue, although the financial barriers for gaining access to essential medicines may be less for prescribers and consumers. Limited public finance from local governments may reduce medicine stock lines of township hospitals and lead them to seek alternative sources of income, jeopardizing their capacity to meet the needs of local consumers.

The effect of the National Essential Medicines Policy on health expenditures and service delivery in Chinese township health centres: evidence from a longitudinal study

ObjectivesThe government of China has introduced a National Essential Medicines Policy (NEMP) in the new round of health system reform. The objective of this paper is to analyse whether the...

The impact of the National Essential Medicines Policy on prescribing behaviours in primary care facilities in Hubei province of China

To assess the impact of the National Essential Medicines Policy (NEMP) on the use of medicines in government-owned primary care institutions in Hubei province of China. Quasi-experimental design and time-trend analysis. A systematic random sampling strategy was employed to select 55,800 prescriptions from 18 primary care organizations who progressively implemented the NEMP from January 2009 to July 2011. We examined the change of patterns of prescriptions. The facilities that implemented the NEMP at a later stage served as control. An immediate increased uptake of essential medicines of all drugs prescribed which ultimately neared 95%. In total, 38,151 prescriptions (68%) involved antibiotics, and we found no evidence of reduction after the NEMP interventions. A high percentage (59-66%) of prescription drugs were administered through parenteral routes and no reduction was found after the NEMP interventions. Although the average number of medicines per prescription remained unchanged (nearly four), the average cost per prescription declined significantly after the NEMP interventions (¥ 44.67 vs ¥ 26.67 CNY, P < 0.03). The NEMP interventions reduced the average cost per prescription; however, the irrational use of antibiotics and unnecessary parenteral administration remains prevalent. The goals of the NEMP are partially achieved; we therefore recommend a strategic approach involving all stakeholders to comprehensively achieve all aspirations.

National Essential Medicines List and policy practice: A case study of China’s health care reform

BackgroundIn 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.MethodsIn 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. ResultsWe 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.ConclusionThe 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.

Effects of China’s national essential medicines policy on the use of injection in primary health facilities

The overuse of injection exists more than 20 years since economic reform in China. It is a persistent problem and seems becoming a new challenge in the new health reform period. This study was designed to assess the effect of national essential medicines policy (NEMP) on injection use at primary health facilities in China by investigating their prescription information. Questionnaires were designed and disseminated to collect empirical data on injection use at 120 primary health facilities in 6 provinces from January to September in 2010 and 2011. The injection use was measured as the indicator as the percentage of prescriptions with one or more injections. The results showed that the percentage of prescriptions with one or more injections was decreased from 38.91% to 36.82% (χ (2)=11.158, P=0.001) in the all survey areas during the NEMP reform. The difference in level of the injection use in 2011 was significant among the eastern, central and western regions (χ (2)=223.584, P=0.000); level of the injection use in western region was the lowest (27.73%), while that in the central region was the highest (43.10%). The level of the injection use in 2011 among different provinces was also of great difference (26.00%-58.25%, range: 32.25%). The level of the injection use in 2011 was still much higher than the standard suggested by WHO for developing countries (13.4%-24.1%). It was concluded that NEMP has improved injection use in China, but the injection abuse situation remains serious, indicating that one of the priorities to the next stage of NEMP is to promote the rational use of drugs, especially the injection use.

An analysis of China's national essential medicines policy

Although China embraced the concept of essential medicines in 1979 and issued its first National Essential Medicines List in 1982, until recently China has lacked a comprehensive national essential drug policy. In its most recent health-care reform (2009-2012), the Chinese government explicitly proposed the establishment of a national essential medicines system, and made it one of five top priorities in the coming years. We review the evolution of China's essential medicines policies, explain the importance of fully implementing the essential medicines policy, and analyze recent policy developments surrounding essential medicines.