China progresses with health reform but challenges remain

Alcorn, Ted; Bao, Beibei

doi:10.1016/s0140-6736(11)60625-9

Cited by 33 publications

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“…Meanwhile, the National Development and Reform Commission (NDRC) regularly lowers medicine prices to ease the burden of patients. In theory, these changes should reduce inefficiencies in drug delivery [7]. However, governments have little information on supply, pricing, distribution, and the use of drugs to help them construct sound medicine pricing policies or evaluate their impact [8].…”

Section: Introductionmentioning

confidence: 99%

Measuring Access to Medicines: A Survey of Prices, Availability and Affordability in Shaanxi Province of China

et al. 2013

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ObjectiveTo measure the prices and availability of selected medicines in Shaanxi Province after the implementation of new healthcare reform in 2009.MethodsData on the prices and availability of 47 medicines were collected from 50 public and 36 private sector medicine outlets in six regions of Shaanxi Province, Western China using a standardized methodology developed by the World Health Organization and Health Action International from September to October 2010. Medicine prices were compared with international reference prices to obtain a median price ratio. Affordability was measured as the number of days’ wages required for the lowest-paid unskilled government worker to purchase standard treatments for common conditions.FindingsThe mean availabilities of originator brands and lowest-priced generics were 8.9% and 26.5% in the public sector, and 18.1% and 43.6% in the private sector, respectively. The public sector procured generics and originator brands at median price ratios of 0.75 and 8.49, respectively, while patients paid 0.97 and 10.16. Final patient prices for lowest-priced generics and originator brands in the private sector were about 1.53 and 8.36 times their international retail prices, respectively. Public sector vendors applied high markups of 30.4% to generics, and 19.6% to originator brands. In the private sector, originator brands cost 390.7% more, on average, than their generic equivalents. Generic medicines were priced 17.3% higher in the private sector than the public sector. The lowest-paid government worker would need 0.1 day’s wages to purchase captopril for lowest-priced generics from private sector, while 6.6 days’ wages for losartan. For originator brands, the costs rise to 1.2 days’ wages for salbutamol inhaler and 15.6 days’ wages for omeprazole.ConclusionsThe prices, availability and affordability of medicines in China should be improved to ensure equitable access to basic medical treatments, especially for the poor. This requires multi-faceted interventions, as well as the review and refocusing of policies, regulations and educational interventions.

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Section: Introductionmentioning

confidence: 99%

Measuring Access to Medicines: A Survey of Prices, Availability and Affordability in Shaanxi Province of China

et al. 2013

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“…A series of healthcare reforms has targeted improvement in access to care in the face of concerns about limited resources, escalating healthcare costs, and lack of affordability. 11 These health reforms are also ongoing with substantial investment in interventions to improve health outcomes. For example, the Ministry of Health has begun implementing clinical pathways for many conditions in hospitals with the aim of standardizing and improving the quality of care.…”

mentioning

confidence: 99%

“…For example, the Ministry of Health has begun implementing clinical pathways for many conditions in hospitals with the aim of standardizing and improving the quality of care. 11 Knowledge of potential barriers to these efforts may inform health policy innovation and guide development of more effective interventions for ACS care and potentially for other hospitalized conditions.…”

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confidence: 99%

System Barriers to the Evidence-Based Care of Acute Coronary Syndrome Patients in China

Ranasinghe

Yao

et al. 2014

Circ: Cardiovascular Quality and Outcomes

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209C hina, a country in the midst of an epidemiological transition, faces many challenges in implementing evidence-based care to curb the growing burden of coronary disease. An aging population and increasing prevalence of cardiovascular risk factors have led to an epidemic of acute coronary syndrome (ACS) across China.1,2 Effective therapies for ACS care, however, continue to be variably used with widespread inequities.3 Furthermore, hospital human resources and adoption of technologies also vary substantially and are particularly limited in rural areas. 4,5 This suggests the presence of significant barriers to implementing change, yet our understanding of these barriers within the healthcare system of China is limited. Particularly, how system factors, that is, the organizational structures, health policies, and the wider social, economic, and political context, may affect efforts to implement evidence at the point of care is largely unknown.Understanding these system barriers is critical given their influence on quality of care. Organizational and wider system factors have been consistently shown to have a significant influence on organizational change, success or failure of implementation of interventions, and their effectiveness. [6][7][8][9] For example, in acute myocardial infarction care, differences in organizational values and goals, senior management involvement, and expertise in acute myocardial infarction care have been identified between high-and low-performing hospitals.10 However, much of our existing understanding about how system factors influence care comes from high-income countries. How they affect care in the unique and dynamic Background-Organizational and wider health system factors influence the implementation and success of interventions.Clinical Pathways in Acute Coronary Syndromes 2 is a cluster randomized trial of a clinical pathway-based intervention to improve acute coronary syndrome care in hospitals in China. We performed a qualitative evaluation to examine the system-level barriers to implementing clinical pathways in the dynamic healthcare environment of China. Methods and Results-A qualitative descriptive analysis of 40 in-depth interviews with health professionals conducted in a sample of 10 hospitals purposively selected to explore barriers to implementation of the intervention. Qualitative data were analyzed using the Framework method. In-depth interviews identified 5 key system-level barriers to effective implementation: (1) leadership support for implementing quality improvement, (2) variation in the capacity of clinical services and quality improvement resources, (3) fears of patient disputes and litigation, (4) healthcare funding constraints and high out-of-pocket expenses, and (5) patient-related factors. Conclusions-System-level barriers affect the ability of acute coronary syndrome clinical pathways to change practice.Addressing these barriers in the context of current and planned national health system reform will be critical for future improvements in the managemen...

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“…By 1992 only 10% of rural residents nationally had health insurance, compared with 90% in the 1970s; preventive healthcare was discontinued, and lack of access to affordable healthcare became a major obstacle to poverty alleviation. In 2000, the percentage of health costs paid out of pocket reached 60% (Alcorn and Bao, 2011). This led to pervasive concerns that getting healthcare was "hard and expensive" ("kanbing nan, kanbing gui").…”

Section: The National Context: Health Systems In China and Indiamentioning

confidence: 99%

“…To a large extent, the debate hinges on the balance between government and market roles (Alcorn and Bao, 2011). The latest reform package, rolled out in 2010, has expanded insurance coverage, reducing rural-urban disparities and guaranteeing the availability of certain priority drugs (Freeman and Boynton, 2011).…”

Section: The National Context: Health Systems In China and Indiamentioning

confidence: 99%

Mobility and health sector development in China and India

Holdaway

Levitt

Fang

et al. 2015

Social Science & Medicine

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a b s t r a c tChina and India are both attempting to create comprehensive healthcare systems in the context of rapid but uneven economic growth and rapidly changing burdens of disease. While in each country the referencing of international policies and work experience abroad have been part of this process, research has yet to examine the kind of knowledge that is exchanged or the various actors involved in knowledge circulation. Based on a study of two sub-national contexts, this article focuses on the role Chinese and Indian health professionals who have studied and worked overseas play in introducing ideas and practices about healthcare provision and health education. We found that experience abroad influenced individuals, institutions, and each society differently and with some contradictory effects. International experience clearly contributed to personal growth and led individuals to support the adoption of new institutional practices, such as more egalitarian relations between doctors and patients and between students and teachers. However, the content of what individuals learned overseas and the mechanisms through which this knowledge was introduced back into homeland settings often reinforced rather than ameliorated institutional hierarchies and social inequalities. While the scope of this research was limited, we suggest that more explicit analysis of the role professional migrants play in transferring ideas and practices within the health sector would be valuable for policymakers and funders seeking to support a more productive interaction between local and global knowledge.

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China progresses with health reform but challenges remain

Cited by 33 publications

References 0 publications

Measuring Access to Medicines: A Survey of Prices, Availability and Affordability in Shaanxi Province of China

Measuring Access to Medicines: A Survey of Prices, Availability and Affordability in Shaanxi Province of China

System Barriers to the Evidence-Based Care of Acute Coronary Syndrome Patients in China

Mobility and health sector development in China and India

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