Effect of the full coverage policy of essential medicines on medication adherence: A quasi-experimental study in Taizhou, China.

Objective: Different forms of full coverage policy of essential medicines (FCPEMs) have been adopted worldwide to lower medication expenditure and improve adherence. This study aims to analyse the effect of FCPEMs on patients' medication adherence in Taizhou city, China. Methods: This study was a quasi-experimental study and set treatment and control groups. We extracted Electronic Health Records (EHRs) for hypertension and diabetes 1 year before and after FCPEMs implementation and their medication adherence level assessed by physicians. We applied the propensity score matching (PSM) method to balance the bias between the two groups. Then, the descriptive analysis was used to compare the differences in the reported medication adherence. Using the Difference-In-Differences (DIDs) method, the fixed-effect model with the logistic regression was built to analyse the effects of FCPEMs. Results: 225,081 eligible patients were identified from the original database. In the baseline year, FCPEM covered 39,251 patients. After PSM, 6,587 patients in the treatment group and 10,672 patients in the control group remained. We found that the proportion of patients with high adherence in the treatment group increased by 9.1% (60.8 to 69.9%, P < 0.001) and that in the control group increased by 2.6% (62.5 to 65.2%, P < 0.001). The regression results showed that FCPEMs significantly increased patients' medication adherence (OR = 2.546, P < 0.001). Conclusion: FCPEMs significantly improved medication adherence. Socially disadvantaged individuals might benefit more from continuing FCPEM efforts. Expanding the coverage of FCPEMs to other medicines commonly used in patients with chronic diseases may be a promising strategy to manage chronic diseases and promote patient outcomes.

Effects of the Full Coverage Policy of Essential Medicines on Inequality in Medication Adherence: A Longitudinal Study in Taizhou, China.

The full coverage policy for essential medicines (FCPEMs) was proposed and implemented in Taizhou city of Zhejiang Province, China, to promote equal access and adherence to medicines. This study aimed to examine the effects of FCPEMs on the income-related inequality in medication adherence among local patients with hypertension or diabetes. We collected electronic health records of patients with hypertension or diabetes of three districts of Taizhou from 2011 to 2016. As the implementation schedule of the FCPEMs varied across districts, we applied a retrospective longitudinal study design and assigned records from 1 year before to 3 years following the implementation of FCPEMs as baseline and follow-up data. We thus generated a dataset with 4-year longitudinal data. The concentration index (CI) and its decomposition method were employed to measure factors contributing to inequality in medication adherence and the role played by FCPEMs. The sample size rose from 264,836 at the baseline to 315,677, 340,512, and 355,676 by each follow-up year, and the proportion of patients taking free medicines rose from 17.6 to 25.0 and 29.8% after FCPEMs implementation. The proportion of patients with high adherence increased from 39.9% at baseline to 51.6, 57.2, and 60.5%, while CI decreased from 0.073 to -0.011, -0.029, and -0.035. The contribution of FCPEMs ranked at 2nd/13, 7th/13, and 2nd/13 after the implementation of FCPEMs. Changes in CI of medication adherence for every 2 years were -0.084, -0.018, and -0.006, and the contribution of FCPEMs was -0.006, 0.006, and 0.007, ranking at 2nd/13, 2nd/13, and 1st/13, respectively. Most changes in CI of medication adherence can be attributed to FCPEMs. The medication adherence of patients with hypertension or diabetes improved after the implementation FCPEMs in Taizhou, although inequality did not improve consistently. In general, FCPEMs could be a protective factor against income-related inequalities in access and adherence to medicines. Future research is needed to investigate the change mechanism and the optimal design of similar interventions.

Factors Associated with Free Medicine Use in Patients with Hypertension and Diabetes: A 4-Year Longitudinal Study on Full Coverage Policy for Essential Medicines in Taizhou, China.

Full coverage policies for medicines have been implemented worldwide to alleviate medicine cost burden and promote access to medicines. However, few studies have explored the factors associated with free medicine use in patients with chronic diseases. This study aimed to analyze the utilization of free medicines by patients with hypertension and diabetes after the implementation of the full coverage policy for essential medicines (FCPEM) in Taizhou, China, and to explore the factors associated with free medicine use. We conducted a descriptive analysis of characteristics of patients with and without free medicine use and performed a panel logit model to examine factors associated with free medicine use, based on an electronic health record database in Taizhou from the baseline year (12 months in priori) to three years after FCPEM implementation. After FCPEM implementation, the proportion of patients without any free medicine use decreased from 31.1% in the baseline year to 28.9% in the third year, while that of patients taking free medicines rose from 11.0% to 22.8%. Patients with lower income or education level, those with agricultural hukou, patients aged 65 and above, married patients, and patients in the Huangyan district were more likely to take free medicines. In conclusion, FCPEM contributed to improved medicine access, especially in vulnerable populations. Local policy makers should consider expanding the coverage of FCPEM to other types of medicines and cultivate the potential of social supports for patients to enhance the effectiveness of FCPEM policies.

Study on the Effects of Full Coverage Policy for Essential Antihypertensive Medicines on the Equity of Medicine Expenditure Affordability in Taizhou City / 中国药房

OBJECTIVE：To provide reference for improving the equity of medicine in China ，and to provide reference for promoting the full coverage policy for essential medicine. METHODS ：Taking hypertension essential medicines full coverage policy in 4 areas of Taizhou in Zhejiang province as an example ，the electronic health records of patients in baseline year and the first ， second and third years after the implementation of the full coverage policy of hypertension were collected. The catastrophic expenditure of family drugs was used to measure the medicine cost burden ，and the effects of policy on the equity and change of local medicine cost burden were analyz ed by means of concentration index and its decomposition method. RESULTS ：With the increase of the proportion of patients taking free medicine ，the incidence of catastrophic expenditure on household medicines in the high，middle and low income group decreased year by year generally （decreasing from 6.3％，12.0％，16.4％ of baseline year to 4.7％，8.9％，12.4％ at the third year after the implementation of the policy ）；the gap among the three groups was in narrowed trendency. The concentration indexes of the baseline year and the first ，second，third year after the implementation of policy were －0.198，－0.186，－0.181，－0.202，the policy contribution rates of which were 0，－1.335％，－4.507％ and 1.936％；and the policy contribution rates in the change of the yearly concentration index were 20.8％，95.0％ and 57.6％. CONCLUSIONS ：The implementation of the full coverage policy for essential medicines is conducive to improving the equity of the medicine expenditure burden. The effect is affected by the implementation of policies and supporting systems ，but the comprehensive promotion of the equity of medicine requires multi-policy synergy.

Economic Evaluation on the Full Coverage Policy for Hypoglycemic Essential Medicines in Taizhou City / 中国药房

OBJECTIVE： To evaluate the economics of the full coverage policy for hypoglycemic essential medicines in Taizhou city， and to provide reference for improving medicine accessibility and essential medicine system in China. METHODS： The electronic health records and financial input data of diabetic patients were extracted from different districts and counties of Taizhou city during 2009-2016. In cohort study design， taking the implementation time of each district and county’s policies as the breakpoint， the data recorded annually were processed as annual data， forming the cohort data for 1 year before （baseline year） and 3 years after the implementation of the policies. According to the choice of free medicines after the implementation of the policy， they were divided into policy group and control group. Propensity score matching was used to balance the differences between two groups to get the final sample， and then the economics of the policy was evaluated with the methods of difference-in-differences. The cost and benefit of implementation policy were calculated. RESULTS： Totally 14 744 people of each group were got by propensity score matching. The mean annual financial expenses on free medicine per capita were 263.8 yuan. Compared with baseline year， mean annual medicine expenses per capita reduced by the policy were 649.2 yuan， and mean annual hospitalization expenses per capita were 624.7 yuan. Thus the input-output ratio of the policy was 1 ∶ 4.8. CONCLUSIONS： The implementation of the policy is beneficial to reduce the cost burden of patients and economical. It can be popularized and sustained through scientific design combined with relevant policies.

Analysis of the Impacts of the Full Coverage Policy for Essential Medicines on the Fairness of Medicine Expenditure Affor- dability of Diabetic Patients in Taizhou City / 中国药房

OBJECTIVE： To provide the empirical basis for improving full coverage policy of essential medicines in China and promoting the fairness and accessibility of medicine. METHODS： Taking Taizhou diabetes essential medicines full coverage policy as an example， the electronic health records of diabetic patients in Taizhou city from 2011 to 2017 were collected， and the cost burden of patients was evaluated by whether catastrophic expenditure of family drugs had occurred. The concentration index was used to analyze the fairness of catastrophic expenditure on household medicines， and the effects of various influencing factors on the fairness of local medicine expenditure affordability were evaluated by year-by-year comparing the relevant indexes from baseline year to the third year of policy implementation. RESULTS & CONCLUSIONS： The concentration index of catastrophic expenditure on household medicines is negative from baseline year to the third year of policy implementation， which indicates that catastrophic expenditure on household medicines for diabetic patients in Taizhou mainly occurs in low-income groups. From the result of decomposition of concentration index， among the factors that affect the fairness of catastrophic expenditure on drugs in diabetic families， the contribution rate of  “taking free essential medicines” keeps at top five places year by year， and the contribution value is positive， which shows that the implementation of policies is conductive to reducing the unfairness of catastrophic expenditure on household medicines in low-income families. Full coverage policy of essential medicines effectively improves the fairness of medicine expenditure affordability. In addition， scientific and reasonable essential medicines selection mechanism， the guarantee level of the policy， collaboration with multiple factors should be promoted so as to improve the fairness and accessibility of essential medicines.

Economic Evaluation of Full Coverage Policy for Essential Hypertension Medicines in Taizhou City / 中国药房

OBJECTIVE： To investigate the effects of full coverage policy for essential hypertension medicines on economic burden of hypertensive patients in Taizhou of Zhejiang Province， and to further provide reference for the practice and promotion of the policy for essential medicines. METHODS： By querying electronic health records database of hypertension patients and statistics of health bureaus in different districts and counties of Taizhou city， the data of electronic health records of hypertension patients were extracted 1 year before and during 3 years after the implementation of full coverage policy for essential medicines in all districts and counties. The patients who had consistently taken free medicines were included in the policy group； the patients who had never taken free medicines were included in the control group. The policy group and control group were matched 1 ∶ 1 by propensity score matching method. Per capita drug cost and per capita hospitalization cost of patients before and after the implementation of full coverage policy for essential medicines were calculated. The input-output ratios of the policy were calculated. RESULTS： During the 3 years after the implementation of the policy， each patient saved 91.3， 272.0 and 464.1 yuan respectively. The hospitalization cost for each patient increased by 65.6 and 46.2 yuan in the first and second year， and decreased by 352.8 yuan in the third year， respectively. A three-year per capita input of policy was 50.0， 147.2 and 278.5 yuan， with input-output ratio of 0.51， 1.28 and 2.25. CONCLUSIONS： The full coverage policy for essential hypertension medicines in Taizhou city demonstrates economic efficiency to some extent， but researches about the impact of policy on disease treatment needed to be conducted. It is necessary for the government departments to invest continuously for a long time and improve the supporting measures so as to make the policy more profitable.