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OBJECTIVE To provide a reference for further improvement of the essential medicine system. METHODS Statistical analysis method and comparative analysis method were used to explain the necessity of coordination between the two systems from the direct correlation and indirect impact of centralized volume-based procurement on the essential medicine system at the present stage. The relevant suggestions were put forward for the development of the essential medicine system in the new era from the perspective of improving institutional synergy. RESULTS & CONCLUSIONS There was a direct correlation between the policy of centralized procurement and the essential medicine system in terms of policy objectives and medicines selection. However， it also indirectly affects the use of essential medicines in medical institutions through production and supply， coincidence degree between the essential medicine list and the selected variety， and the consistency evaluation of generic drugs. It is suggested that in the selection of essential medicine list in the future， priority should be given to the selection of varieties through centralized procurement， and improve the drug supply guarantee capacity under the dual policy linkage； at the same time， incentive assessments for the allocation and use of essential medicines by various entities should be further strengthened to promote the further improvement and development of the essential medicine system.
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OBJECTIVE:To explore losses and gains (L&G) and L&G ratio induced by Essential Medicine System in a county. METHODS:By choosing a county in western China as sample area,field investigation was used to collect outpatient and inpatient visits,outpatient and inpatient income,drug income,total length of stay and medical insurance reimbursement criteria in primary medical institutions (township health centers,village health rooms) of the county during 2009-2015. By setting the year 2009 as the baseline year,the drug cost reimbursed by medical insurance was simulated and calculated when Essential Medicine System were not implemented;L&G and L&G ratio of medical insurance were calculated by comparing with actual drug cost reimbursed by medical insurance. RESULTS:The year 2012,in which the sample county fully implemented the Essential Medicine System was the turning year. Medical insurance funds lost in primary medical institutions of the county during 2010-2011(lost 437000,915000 yuan,respectively),but gained during 2012 to 2015(gained 199000,494000,858000,1290000 yuan, respectively);the L&G ratio increased from -0.67％ to 1.21％. For reimbursed outpatient drug cost and inpatient cost,L&G of medical insurance were different. For reimbursed drug cost of village health room and township health center,L&G of medical insurance were also different. CONCLUSIONS:The implementation of Essential Medicine System benefits to medical insurance within the county and Medical insurance funds can be saved.
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OBJECTIVE:To evaluate the effects of the implementation of National Essential Medicine System on the utilization rate of hormone drugs in primary medical institutions in China systematically.METHODS:Retrieved from CJFD,Wanfang database and VIP,the literatures about the use of hormone drugs were collected before and after the implementation of National Essential Medicine System.Meta-analysis was performed by using Stata 13.0 software after utilization rate dam extraction and quality evaluation with Cochrane system evaluator manual 5.1.0.RESULTS:A total of 20 literatures were included.Results of Meta-analysis showed that utilization rate of hormone drugs after the implementation of National Essential Medicine System was significantly lower than before implementation,with statistical significance [RD =-0.03,95 ％ CI (-0.05,-0.02),P＜ 0.001].Results of subgroup Meta-analysis of utilization rate of hormone drugs in different areas before and after the implementation of National Essential Medicine System showed that the utilization rate of hormone drugs in eastern areas was significantly lower after the implementation of National Essential Medicine System than before [RD=-0.06,95％ CI(0.09,-0.03),P=0.001] with statistical significance.There was no statistical significance in the utilization rate of hormone drugs in middle area [RD=-0.02,95 ％ CI(0.06,0.02),P=0.235] or western area [RD=-0.01,95％ CI (-0.02,0),P=0.122] before and after the implementation of National Essential Medicine System.CONCLUSIONS:The implementation of National Essential Medicine System reduces the utilization of hormone drugs in primary medical institutions.The effect of the eastern area is more obvious than in middle and western area.
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The implementation of the essential medicine system in China faces problems including the lack of compelling force of the existing law,Lack of legal authority on the essential medicine list,the unreasonable selection mechanism of medicines,the appearance of problems about the medicine procurement mechanism legalization process, lack of legal use mechanism,the unreasonable financial compensation mechanism,and the lack of effective supervisory regulation mechanism. Therefore,it is recommended that when formulating the basic medical and health law, the es-sential medicine system should be constructed under the ethical and framed stimulation from a macro and scientific point of view. It is also suggested that the legal status of the national essential medicine list should be defined,scientifically selecting the essential medicines, improving the essential medicine bidding procurement system, using the essential medicines under the appropriate law,determining the reasonable compensation mechanism and improving the essential medicines regulation mechanism.
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OBJECTIVE:To provide reference for the further promotion ofNew Medical Reformand the further implementa-tion and improvement of National Essential Medicine System. METHODS:By systematic sampling,1728 outpatient prescriptions were randomly selected from a community health service center in Foshan during 2012 to 2015,and then analyzed and compared statistically in respects of the amount of drugs,rational drug use indexes,prescription cost,main disease composition,treatment cost. The change rules and characteristics of all the above mentioned information were all studied. RESULTS:The average number of medicines per prescription and the number of essential medicines decreased year by year,Comparied with 2012,the proportion of antimicrobial agents,the proportion of two or more antimicrobial agents,the proportion of injection prescription and the propor-tion of transfusion prescription were significantly reduced,the cost of medical treatment of patients decreased significantly;medi-cine cost and medicare reimbursement amount had increased to different extents,there was statistical significance(P<0.05). Multi-ple linear regression analysis(stepwise)showed that the cost of medical treatment was closely related to rationality of prescriptions. Respiratory diseases,cardiovascular and cerebrovascular diseases,gastrointestinal diseases were the top 3 of the major diseases, the proportion of prescriptions for respiratory diseases,gastrointestinal diseases decreased year by year,while that for cardiovascu-lar and cerebrovascular diseases increased year by year. CONCLUSIONS:The promotion ofNew Medical Reformand the imple-mentation of National Essential Medicine System play a positive role in promoting rational drug use and the quality of medical ser-vice in community health service center. However,there are still many problems in the community health service centers,such as too many medicines each prescription,the lack of diagnosis and treatment ability,the defects of medicine selection and administra-tion.
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OBJECTIVE:To provide reference for promoting the further implementation of national essential medicine system and rational use of drugs in community health service center. METHODS:Outpatients’information in Changqiao Street Communi-ty Health Service Center from Sept. 2,2009 to Nov. 25,2014 was collected to statistically analyze the drug variety,the number of prescriptions,the consumption sum and the DDDs before and after the implementation of essential medicine system and after the supplement of non essential medicines. RESULTS:Essential medicines occupied the main position of drug utilization in each stage, with substantial growth in respects of consumption sum and number of prescriptions;the sum of Chinese patent drugs and essential cardiovascular drugs occupied more than 50% of the total consumption sum and number of prescriptions,with higher growth rate;essential medicines occupied the top 10 in respects of consumption sum and DDDs,among which most were the drug varieties in“Shanghai supplement essential drugs in community health service center”(2010 Edition),with some overlap the varieties in“Na-tional Essential Medicine System”(2012 Edition);cardio-cerebrovascular drugs occupied the dominant position;the growth rates of cefotiam and atorvastatin took up the top 2 ranking in the list of consumption sum,while the growth rates of calcium carbonate D3 and irbesartan and hydrochlorothiazide took up the top 2 ranking in the list of DDDs. CONCLUSIONS:Essential medicine cata-log covers the common drugs in the community health service center,in which the rational use of Chinese patent drugs and antibac-terial deserves needs to be noticed. The clinical rational use of the essential medicines should be strengthened,the essential medi-cine catalog should be adjusted and non essential medicines should be supplied when necessary in order to truly meet the needs of patients and optimize the allocation of medical resources.
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OBJECTIVE:To provide reference for further developing the use of national essential medicine system and formulat-ing the plan for essential medicine that is consistent with the local situation. METHODS:A questionnaire survey was conducted on site to collect the 1 800 medical staffs chosen from 35 community health service institutions in Xinjiang with multi-stage stratified random cluster sampling to investigate the cognition to the national essential medicine,and it was statistically analyzed by SPSS 13.0 software. RESULTS:Totally 1 800 questionnaires were sent out and 1 642 were effective received with effective recovery of 91.2%. 26.5% acquired such specialized knowledge through professional training,and 50.0% by books and Internet;62.4% did never participated in training. Only 20.2% shared it for patients. The average score of recognition for the system was(6.09±2.86) scores,which was related to age,education,profession,work experience and the title (P<0.01). 75.2% supported this system. CONCLUSIONS:The basic medical staff just have some know of the concept of national essential medicine,but the understanding is still low. It is suggested to improve the cognition level by seminars and continuing training to strengthen reliability of all ethnic groups on essential medicine,change their bad medication habits,popularize common sense of rational drug use and form a good atmosphere for the implementation of the national essential medicine system in the whole society.
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OBJECTIVE:To improve the distribution rate of essential medicines,to meet the medication needs in primary health care institutions. METHODS:The in essential medicine distribution in primary health care institutions was analyzed,and combined with the current essential medicine policy regulations,problems existed in the bidding work program of distribution enterprises that made by health departments were summarized,and countermeasures were put forward. RESULTS & CONCLUSIONS:Resources in medicament circulation industry get further integration,the industrial structure is optimized and upgraded,and the distribution rate is comprehensively improved after the implementation of national essential medicine system in Qinghai province. But there are still some problems,including serious monopolies in wholesale and sales enterprises,insufficient supply of some biding drugs,low distribution rate,inadequate supervision of relevant authorities,unreasonable regional distribution of drug retail stores and low qual-ity of distribution companies. For above-mentioned problems,relevant government departments should strengthen supervision and propaganda of relevant laws,regulations and policies for medicine distribution,intensity to supervise medical institutions,intro-duce competition mechanism,establish advanced pharmaceutical distribution and increase capital investment in drug sales in remote areas to effectively improve distribution rate of essential medicines and meet the needs of primary medical institutions.
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OBJECTIVE:To provide reference for promoting the further implementation of national essential medicine system and related policies. METHODS:Hospital information system(HIS),Excel 2007 and SPSS 13.0 software were adopted to statisti-cally compare the changes in equipping the specific varieties of national essential medicines and the differences in the overall use of national essential medicines before and after implementing the National Essential Medicine System (2012 edition)(referred to NEMS,2012 edition) and cancelling drug addition policy in a public hospital in Chengdu. RESULTS:After implementing the NEMS(2012 edition),60 kinds of equipping national essential medicines increased in the hospital,including 38 kinds of chemical medicines and biological products,22 kinds of Chinese patent medicines;compared with before,the percentage of essential medi-cines to prescription drugs,prescription rate of essential medicines,average essential medicine in a single prescription and prescrip-tion rate of all essential medicines were significantly improved(P0.05). CONCLUSIONS:After implementing the NEMS(2012 edition)and cancelling drug addition policy,the equipping na-tional essential medicines are still insufficient,some indexes do not meet the requirements of Sichuan Province. It is suggested that the public medical and health institution at county-level should to choose suitable national essential medicines based on its specific situation;strengthen publicity and education,improve the popularity of physicians to national essential medicine system;strengthen the assessment and management of the use of essential medicines for physicians. Meanwhile,the government and the relevant de-partments are suggested to explore more effective and reasonable compensation mechanism to improve the enthusiasm of physicians to use the national essential medicines.
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OBJECTIVE:To provide reference for improving the national essential medicine system and satisfy the needs of ra-tional use from the public METHODS:The current situation and existing problems in the national essential system were described by literature research and comparative analysis,and recommendations were presented. RESULTS:The implementation of essential medicine system has certain effects in China,but there still remains some problems,involving too much variety of essential medi-cines,high price and others,and limitation of the use of medicine and distribution in primary medical institutions. CONCLU-SIONS:Government should further simplify the essential medicine lists,reduce prices,strengthen policy support for primary medi-cal institutions,deepen the national essential medicine system and protect the public's rational drug use.
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OBJECTIVE:To provide reference for the further improvement of national essential medicines system. METHODS:Taking theBull's-eyecity Chengdu as an example,based on the trading areas,the existing problems in implementing essential medicine system were analyzed by qualitative and quantitative research methods,and countermeasures were put forward. RESULTS:From the point of view of quantitative data,the first level trading areas of both proportions of medical personnel per thousand ur-ban population and numbers of primary medical and health institutions per 100 thousands population in Chengdu were the lowest. From 2010 to 2012,the outpatient and inpatients increased 1.09 million people and 0.16 million beds per day in Chengdu primary health care institutions,the largest increase in the first level trading areas,and increase and decrease in the second and third level trading areas;outpatient and inpatient drug costs fell respectively 4 yuan and 109 yuan,medicine proportion declined 6.7%,in-crease in the first level trading areas,and decreased to varying degrees in the second and third level trading areas. From the point of view of qualitative interviews,the service ability got enhancement,but still could not meet the services demand,especially the pressure in the first level trading areas near center district remains heavy;drug cost was under controlled,but the subsidies needs to be increased,the per capita drug costs in the first level trading areas remains high;the drug income and medicine proportion were inhibited,especially the significant fell in the second and third level area,but the decrease of income may restrict develop-ment. CONCLUSIONS:It is suggested that more targeted drugs are needed for meeting the services demand,more sophisticated policy are needed for improving the subsidies,and more comprehensive medical conditions are needed for ensuring institutions'de-velopment.
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OBJECTIVE:To provide reference for improving the policies and countermeasures for national essential medicines. METHODS:The existing problems of medicine distribution under essential medicine system were analyzed and countermeasures were put forward. RESULTS:Due to the regional economic environment and industry development level differences,local policy had conflict with national laws and regulations,lacking of systembasis in regulatory process and drug centralized bidding and pur-chasing department weakened responsibility in terms of administrative supervision when performing national essential medicine sys-tem;distribution distribution capability had weakened,distribution enterprise internal management was not standard,the essential medicine storage and distribution process quality showed safety hidden risks in terms of marketization. It is suggested to establish and improve the national essential medicine system overall implementation programs and regional implementation programs,inte-grate medicine distribution market,explore and establish modernized pharmaceutical logistics system,intensify supervision and management of distribution,support distvibution transformation development to reduce social risk and further improve bidding and purchasing mechanism to reduce distribution costs. CONCLUSIONS:The existing problems in distribution can be gradually solved only by further promoting the medical and health system and improving the national essential medicine system.
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Objective To study the impact of essential medicine system on rational drug use in Community Health Care Center of Chun′an District .Methods Essential drug system in Community Health Care Center of Chun′an District in Zhejiang Province was taken as the intervention group ,and before implementation was taken as contrast group ,the essential medicin system was analyzed whether it was or not to promote the rational use of drugs by prescription surveys .Results Average num-ber of drugs per encounter was lower from 2 .68 to 2 .23(P< 0 .05) ,average expenditure per encounter was lower from 42 .11 yuan to 37 .75 yuan(P<0 .05) ,the use of essential medicines was riser from 79 .90% to 89 .81% (P<0 .05) ,the three in-dexes had significant difference ,the percentage of injections per encounter was lower from 37 .87% to 28 .50% (P>0 .05) ,the percentage of antibiotics per encounter was lower from 36 .52% to 24 .46% (P> 0 .05) ,the two indexes had no significant difference .Conclusion After execution of essential medicine system in Community Health Care Center of Chun′an District ,av-erage number of drugs and average expenditure per encounter were lower and the use of essential medicines was riser ,but the percentage of antibiotics and percentage of injections were not been improved ,belonged to irrational category ,although there had essential medicines manual ,but effective promoting measures still was deficient .
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OBJECTIVE:To provide reference for the further implementation of national essential medicine system of township hospitals. METHODS:5% township hospitals in a province were collected as sample by using random cluster sampling method, and statistics,comparison and evaluation was made by issuing questionnaires to get health resources distribution status,health ser-vice status and income and expenditure status before(in 2009 and 2010)and after(from 2011 to 2013)the implementation of na-tional essential medicine system of township hospitals. RESULTS:Totally 46 township hospitals were surveyed and totally 46 ques-tionnaires of township hospitals were recycled. Average number of beds in township hospitals increased from 15.1 beds in 2009 to 19.4 beds in 2013. Average annual outpatients increased from 11 200 in 2009 to 16 100 in 2013,and average number of hospital discharge increased from 644 in 2009 to 924 in 2013. The proportion of government financing to total income increased from 25.9% in 2009 to 47.1% in 2013,proportion of drug income to the total income decreased from 54.9% to 29.7%,drug profit rate decreased from 25.5% to 3.7%,and proportion of township hospital under deficit decreased from 17.4% to 4.3%. Average time that residents see a doctor in township health center increased from 0.47 in 2009 to 0.74 in 2013,and cost of average hospitaliza-tion and outpatient drugs decreased from 805 to 718 and 28.1 to 24.1,respectively. CONCLUSIONS:The implementation of nation-al essential medicine system has no negative effect on outpatient service,but first inhibits then promotes the inpatient services. Na-tional essential medicine system has effectively cut down the financial burden of drugs,but it has no effect on total health burden. It is difficult to realize the excessive rapid rise of health ex-pense by the single implementation of essential medicine sys-tem,and it needs comprehensive reform,collaboration and in-teraction of medicine and health to effectively relieve the prob-lem of“expensive ill”.
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Objective:To study the status quo of National Essential Medicine System ( NEMS) in village clinics of a province in western China. Methods:Individual in-depth interview was carried out with village doctors and their managers of a province in western China, to understand the subsidies of zero-markup rate, compensations for general medical fees, and status quo of NEMS assessment mechanism and its impacts on prescribing behavior of village doc-tors. Results:In the surveyed area, the intervention of NEMS has not achieved the desired objectives: the prescri-bing behavior of village doctors has not changed significantly;general medical fee system has failed to achieve reason-able compensations;and the assessment mechanism done by village doctor managers has been a mere formality. Con-clusions and Suggestions:To ensure the feasibility, effectiveness and sustainability of the intervention, the area poli-cymakers should take into full consideration the special nature of village doctors.
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Objective:To conduct a systematic review on the implementation effects of National Essential Medi-cine System ( NEMS) since the new health care reform and provide some suggestions to further improve the NEMS. Methods:Databases and relevant international organization reports were searched to collect studies related to the im-plementation of NEMS in China. The database search occurred from January 2009 to December 2014. Results:A to-tal of 1 292 studies were finally included, encompassing 1,277 Chinese papers, 12 English papers, and 3 WHO/HAI reports. A lot of researches have been done on NEMS, but the techniques of NEMS evaluation are not perfect. The sample representativeness is poor, and the longitudinal follow-up studies of the microscopic view is insufficient. . Evi-dence-based evaluation research using big data has just started. Conclusions: The research on NEMS should be strengthened. The NEMS evaluation should not only be based on national conditions, but it should also be in combi-nation with an international, multidimensional evaluation framework in terms of availability, affordability and rational drug use, so as to provide evidences to perfect the NEMS.
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Objective:To analyze the effects of essential medicine system on revenue structures at primary med-ical institutions. Methods:Data on revenue status and structures from 58 township health centers in Shanxi Province was collected to analyze changes and trends. Results:Along with growing government investments in primary medical institutions, the essential medicine system has fundamentally realized full coverage. The percentage of essential medi-cine revenue to pharmaceutical revenue rose from 20 . 45% in 2009 to 97 . 03% in 2013 , though the percentage of pharmaceutical revenue to total revenue dropped by 18 . 43%. The percentage of fiscal subsidy revenue in total reve-nue rose from 25 . 77% in 2009 to 54 . 16% in 2013 , though the percentage of business revenue to total revenue dropped in general. Conclusions:The essential medicine system requires the government’s financial support. Essen-tial medicine lists and primary financial aid policies should be further improved;doctor reimbursement and incentive mechanisms should be improved as well and unreasonable doctor service pricing and reimbursement mechanisms should be reformed.
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OBJECTIVE:To provide reference for further optimizing the implementation of national essential medicine system in Liaoning province. METHODS:54 primary medical institutions in Liaoning province were selected,and document research,data collect and comparative analysis were performed for the statistical analysis of equipment,usage and distribution of essential medi-cines,etc. RESULTS:The average equipment of essential medicines in surveyed institutions in the 3rd quarter of 2012 and 2014 were 223.8 and 325.0 product regulations,respectively,with equipment rates of 42.9% and 46.8%;average outpatient prescription drug expenses per person in community health service centers in the 3rd quarter of 2012 and 2014 were 61.7,62.1 yuan and town-ship hospitals were 38.1,39.8 yuan,respectively,which were higher than national average level;shipping amount of manufactur-ers with the top 24 shipping amount was 43.00% to total amount,and 58 manufactures had no shipping amount;usage amount of varieties with the top 7 usage amount was 25.77% to total usage amount of essential medicines;distribution amount of commercial companies with the top 4 distribution amount was 41.27% to total amount. CONCLUSIONS:54 primary medical institutions in Lia-oning province equipment exist some problems,including low distribution rate,high price,shortage of medicines,high usage and distribution concentration,and so on. It is suggested that distribution enterprises should strengthen the construction of supply chain platform,optimizing distribution network and improving distribution capacity,and the government should strengthen supervision and financial support based on guarantee of reasonable profits of production companies and distribution companies.
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OBJECTIVE:To provide basis for the further implementation of the national essential medicine system in township hospitals. METHODS:By issuing questionnaires,an investigation was made on the basic information of township hospitals imple-menting“Health Ⅺ project”in Heilongjiang Province before and after the implementation of the national essential medicine system. Prescriptions of 4 days in 2008 and 2012 were extracted,statistically compared and analyzed by using random system cluster sam-pling medication rationality was evaluated. RESULTS:40 questionnaires and 3 173 prescriptions were recycled during the investiga-tion in 2009,and 40 questionnaires and 4 197 prescriptions were recycled in 2013. Compared with the township hospitals in project areas in 2008,the proportion of practice(assistant)physicians per township hospitals and the average number of beds were respec-tively increased by 1.5%and 4.6 in 2012. The average kind of prescription drugs was decreased from 2.9 kinds to 1.7 kinds,the us-age rate of infusion was decreased from 46.5%to 30.6%,antibiotics was decreased from 61.5%to 40.0%,two or more kinds anti-biotics was decreased from 18.9% to 4.8%,hormone was decreased from 11.9% to 4.2% and the rate of combined use of antibiot-ic and hormone was decreased from 9.2% to 2.8%;the drug expenditure of each outpatient service and hospitalization was respec-tively decreased 19.1% and 16.4%. There were significant differences(P<0.05). CONCLUSIONS:After the implementation of na-tional essential medicine system,the medication rationality of township hospitals in project areas has made great improvement,es-pecially on the aspects of prescription drug number,the combined usage rate of antibiotic and hormone,the usage of hormone and the drug expense burden,which reaches the policy targets;although the infusion rate and the usage of antibiotic show great im-provements,there are still some gaps between the current situation and the policy targets;the obvious decrease of the average drug expenditure of each service doesn’t make a relative decrease of the average expenditure of each medical service,which has a little increase.
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To study performance problems found in China's essential medicine system.The SmithModel of system implementation was called into play in a systematic collation and analysis for the ideal policies,system implementation agencies,target groups and policy environment in its performance,along with relationships among the four factors.The system is found with a number of loopholes as the system itself is highly idealized,its system objectives set inappropriately,problems found with the four factors,and tension and conflicts among these factors.Given these problems found in its performance,it is inappropriate to make drastic changes to avoid instability of the system at its early stage.Government departments in question are advised to comprehensively analyze the four factors and their relationships then taking effective measures to deal with them and the tension,conflict among them.This can ensure effectively implementation of the essential medicine system.