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

Abstract

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.

Health system reform in rural China: Voices of healthworkers and service-users

“…More than 90% of low and middle income countries have essential drug lists (Tian et al, 2012) which are seen as necessary to ensure access to safe, effective medication, to encourage rational prescribing and to contain costs. In primary care in China, the list is closely linked to the zero mark-up policy, and constitutes a major plank of the reforms.…”

“…There are between 100 and 200 additional drugs on the essential drug list in different provinces (Li et al, 2013). The longer term plan is to introduce zero mark-up at county level and this has now started in some counties (Tian et al, 2012). 3) Introduction of fixed salaries set by local government for township healthworkers, to compensate for loss of income from drug sales and is equivalent to a secondary school teacher.…”

China's Health Reform Update

“…Upper-tier facilities are encouraged, but not required, to follow the policy (46). Provinces are allowed to independently create supplemental lists, providing the system with flexibility to adapt policy to local needs (23,65). Hospitals are no longer allowed to buy medications directly but instead have to purchase medications through a bidding process managed by the provincial government.…”

Ongoing Initiatives in China to Enhance Prescribing Efficiency: Impact and Proposals for Improvement

“…Demand-side measures to enhance the quality and efficiency of care include the development of an essential medicine list, clinical guidance and guidelines [2,4,8,19,29]. However, there are currently few initiatives among public insurers to monitor the quality of prescribing in China [20,23].…”