Research On Evaluation Of The Implementation Of Essential Medicines System In Shanghai

1. BackgroundSince the implementation of Essential Medicines System (EMS) in China, there are many studies of evaluation from all over the country. The initial position of EMS by WHO is directed to poor area, poor people, but no longer limited to poor countries gradually. The meaning of essential medicines was also gradually, the initial emphasis is the availability of medicines, then gradually increase the factors of rational drug use, cost-effectiveness and so on. So the effects and focus of EMS wii be different for areas with different economic levels. China has a vast territory, and large differences in regional economic level, the effect and expected results brought by mplementation of EMS will be different in different development level regions. As developed region, there should be a specific evaluation for Shanghai to find obstacles in the implementation process.The significance of Shanghai area evaluation lies not only in the discovery of local problems. For a long time, China has formed a stable drug circulation system, drug manufacturers, distributors, hospitals can meet the expected benefits with the established rules though the drug circulation. The system running steadily showed the results of drug supply, price and cost. The implementation of EMS involves all aspects of the drug circulation system, has it changed the running mechanism of original system? What is the principle of action? These are universal. Through the changes of indicators in Shanghai can answer how much disturbance effect brought by EMS implementation for original system. By analyzing the mechanism of such a result can summarize regularity to provide services for the implementation of EMS in other areas.In summary, by analyzing the effect of EMS implementation in Shanghai to answer whether the implementation caused disturbance effect for original drug system or not, and explore the mechanism of the results is the main significance of the research.2. Objectives and ContentsThe research aimed to clear the extent of problem solution after the implementation of EMS, whether the goal of EMS achieved, the implementation of measures and the existence of unexpected impact.Research contents includes:(1) The change of the availability of essential medicines. (2) The change of the affordability of essential medicines. (3) The change of rational drug use. (4) Study on the compensation of medical institutions. (5) Study on the integration situation of drug market.3. Logic And MethodsThe evaluation of a system should be from multiple dimensions. First of all should establish the framework of the evaluation. The implementation of any system has a problem to be solved, objectives to be achieved and measures need to be implemented. The evaluation should be able to answer whether the process of measures implementation is stable, the targets is achieved and the problem is resolved. Therefore, the framework can be established from this point of view. Following the above ideas, first clarify the problems, objective, and measures of EMS. Then establish the framework from the three dimensions in five aspects, that is drug availability, affordability,rational use,medical institution compensation and market integration. Finally determine the expression indicators of the framework based on the existing related index system and the actual situation of the obtained data.Material Sources:(1) Selected three community health service centers (CHSC) in urban areas as representatives of city, three suburbs CHSCs as rural representatives. Data collected included:drug configuration data of CHSC between 2010-2011, all prescription records between 2010-2011 and obtain the financial statements between 2010-2011 of all the CHSCs from information center of Shanghai Health Bureau. (2) Interview the patients and doctors on duty of sample CHSCs. include:the awareness of EMS, the perception of changes in the cost, doctors prescribe convenience etc. (3) Select a district of Shanghai as the sample area of market integration suivey, obtain the drug purchasing data of all the medical institutions from 2010 to 2011. Including: code of drug, purchase price, retail price, purchase quantity, manufacturers and distribution companies. (4) According to the guidelines for clinical application of essential medicines identified 58 kinds of commonly used drugs of the top ten diseases. Investigate these drugs’price in a pharmaceutical retail chain store.Quality Control:The prescription data of this study all derived directly from the database as Shanghai has achieved electronic prescription; the financial data was from the; the drug procurement data exported directly from the pharmaceutical bidding database; questionnaire were all asked by the investigators with pre-investigation before the formal survey.Analysis Methods:Before and after comparison, half-yearly changes comparison, grassroots and non-grassroots comparison, urban and rural comparison were used in this research.4. Research ResultsThe EMS running steadily. (1) The Grass-roots pharmaceutical market remained stable. Though the comparison of grass-root sales market and non-grass-root sales market, half-yearly changes before and after the implementation of EMS. Total sales amount of grass-root sales market was increased and the declining of grass-root market’s sales has been reversed. (2) The primary medical institutions running steadily. After the implementation of EMS, the government input has increased by 8.46 billion, the balance of drug has reduced by 3.19 billion, the balance of medical service has reduced by 7.51 billion, in which the personal expenditure has increased by 5.24 billion. The increasing government input is enough to cover the cancellation of drug markup rate and the escalation of human resources cost. (3)Patients has no obvious feelings, doctors prescribed with a slight influence. More than half of patients din’t know about the EMS,56.82% of urban patients,65.79% of rural patients thought the treatment costs did not chang; doctors showed the implementation of EMS caused some inconvenience to prescribing, but more than half of them said the impact was little and the patients could understand and accept.The objectives of EMS has been basically achieved. (1) Lower drug prices. The supply price of medicine which is weighted and standardized has reduced by 1.32 yuan, a decrease of 6.03%; the weighted retail prices of drugs has reduced by 2.98 yuan, a decrease of 11.83%.(2) The availability of essential medicines has been improved. The equipped rate of essential medicines increased, with the proportion of drugs accounted for directory an increase of 4.36 percentage points; the availability median of global core directory drugs belongs to high availability according to the WHO standard.(3) The rational use of drugs was improved.6 indicators including drug expenditures per prescription, drug type’s quantity per prescription, drug’s quantity per prescription, percentage of antibiotic, percentage of hormone, percentage of injection all decreased. The drug use of rural CHSCs was greatly improved by the implementation of EMS. (4) The integration of pharmaceutical market has been strengthened. EMS showed shuffle effect on the pharmaceutical industrial enterprises in the Grass-roots terminal market. CR1, CR4 and CR8 elevated by 6.18%、17.52% and 29.96% respectively in the second half of 2011; EMS did not show market crowding-out effect in commercial enterprises and promoted the CR of commercial enterprises slightly.The problem solving of drug costs is limited, and the medical tests costs is rising.(1) The reduction of drug price did not bring down the cost of drugs to the same degree:the average outpatient and emergency department drugs expense of each time has decreased by 5.87%, the average hospitalization drugs expense of each time has decreased by 3.42%.(2) The CHSCs had the income-generating behavior by increasing the tests:the average outpatient and emergency department medical expenses of each time has increased by 17.43%, the average hospitalization medical expenses of each time has increased by 14.22%.5. Discussion and SuggestionsDiscussion on the mechanism of the action of EMS. The EMS slowed down the rising rate of the drug prices in the future and cutted off the main interests of the association between hospital and medicines expenses. However, due to the steady-state characteristics of system, the hospital in order to maintain their own interests, they will increase inspection in the short term. In addition, cause of the limit of total amount of medical insurance, the hospital will not make the total cost dropped significantly to ensure the cost of next year.Discussion on the adjustment of EMS. One is the complement of loss: adequate financial compensation, or raise the price of medical services, or allow institutions to sell the medicines outside of the directory. Another is the change of mechanism, turn round the positive correlation between the hospital’s income and medical cost, though the combination of payments reform and EMS to prompt doctors get benefits by cost saving.