Study On The Implementation Analysis And Countermeasures Of The Full Coverage Policy For Essential Medicines In Pilot Areas In China

Objective:Full coverage policy is an effective way to promote the equity and accessibility of medicines.The aims of this study are to systematically summarize the historical evolution,current implementation status,problems existing during the implementation,and feasible and practical experience of Full Coverage Policy for Essential Medicines in pilot areas in China,to provide evidence for promoting National Essential Medicine Policy in China.Methods:This study systematically summarized the general implementation status and practice experiences of international and domestic Full Coverage Policies for Essential Medicines through literature and policy review.Field surveys were conducted in 6 provinces(cities)to obtain accurate first-hand detailed information of implementation of relevant policies.Tailored questionnaire was proposed based on detailed literature and policy review,current status of policy implementation in pilot areas,and multi-round of expert discussions.Through questionnaire survey of various stakeholders,this study summarized the key factors for policy design of Full Coverage Policy for Essential Medicines in China,including policy objectives,financing methods,covered medications,covered diseases,covered patient population,coverage process,supportive policies,etc.Existing problems during implementation and suggestions for the policies were also collected during the questionare survey.Results:Since the provision of free medicines to hypertension patients in Waigang town in Shanghai in 2001,there have been a total of 16 provinces and 47 cities(counties)piloting the full coverage policies for essential medicines as of the end of 2019.Thefield survey of the selected six representative regions for detailed analysis showed that,the implementation of the Full Coverage Policy for Essential Medicines in China promoted equitable access to essencial medicines and health services,improved the clinical control of patients’ diseases,and reduced the incidence of related complications to a certain extent.As for the questionnaire survey,a total of163 valid questionnaires of experts from various stakeholders across 20 provinces were included in the sample.Among them,98.2% of the interviewed experts supported the widely implementation of Full Coverage Policy for Essential Medicines in China.Most of the experts believed that the Full Coverage Policy for Essential Medicines should be devoted to improving equitable access to essencial medicines and health resources,thereby improving the health status and alleviating the financial burden for the patients,especially for those in poverty.More than 55%of experts thought that policies should cover chronic diseases such as diabetes and hypertension that are common at the primary healthcare institutions.When it comes to medication selection,88.3% of the experts favored that patient needs in primary healthcare were needed to be given fully consideration.Besides,the interviewed experts generally suggested that community healthcare centers(79.1%),township hospitals(78.5%)and other primary healthcare institutions should be the basic settings to dispense full coverage medicines.To really improve the health status of patients under coverage,93.9% of the interviewed experts believed that regular follow-up and management practices for the patients were needed to ensure the appropriateness of drug use and treatment therapies.However,there were still some problems during the implementation of the policy.For example,83.4% of the experts proposed that the patient’s awareness and understanding of the policy were low;77.9% proposed that the drug delivery system of the full voverage drug was insufficient;63.8% of the experts thought that the doctors in primary healthcare were generally lack of knowledge and ability;and 66.9% of experts pointed out that inappropriate use of medicines,excessive medical care and corruption were problems that could be overlooked.Conclusions:This study demonstrated that the Full Coverage Policy for Essential Medicines in China should take the promotion of eqiutable access as the main goal and coordinate with the improvement of the National Essential Medicine Policy.Severalkey factors should be taken into account in establishing and improving the policies.Populations with certain diseases are coverd by the policy first,followed by the gradually realization of full coverage of all of the essencial medicines.Policy design is supposed to meet the main needs of patients in primary healthcare sepecially of those in poverty,and regular adjustment of coverage medicine lists is needed.At the same time,we should improve the drug supply system and establish an effective and efficient supportive management and supervision mechanism to improve the rational use of medicines for both doctors and patients.In terms of the drug finance,the policy should have an independent financing system to ensure the sustainable development of the policy.