| The pharmaceutical sector plays an important role in the medical and health system. National Essential Medicines Policy is an important component of National Health Policy; it is also the core context of the National Medicines Policy. Chinese health system is being faced a dramatic change and reform. Establishing National Essential Medicines System is one of the five priorities of the ongoing health care system reform in China. Its ultimate goal is to provide the best pharmacy service for the health and well-being of the nation. National Essential Medicines System can ensure the efficacy, safty, availability, and affordability of essential medicines for the public, contain the escalation of pharmaceutical expenditure, relieve the disease burdern of society and public, and guarantee the equitable access to essential medieines.This study collected international literature of WHO and some countries' plan and practice on National Essential Medicines Policy. After systematic review and comparison, we concluded some experience on design and implementation of National Medicines Policy,Essential Medicines Policy and Essential Medicines System.This study considered the structure and some of the trends in health expenditure over the last three decades and pharmaceutical expenditure over the last ten years, confirmed that both total health expenditure and pharmaceutical expenditure have increased rapidly per annum and the percentage of health expenditure particularly for pharmaceuticals has always been maintained at a relatively high level,and appraised the elasticity coefficient of pharmaceutical expenditure over health expenditure. We concluded that the pharmaceutical expenditure containment is important in controlling the rise in health expenditure.This study analyzed the history and current policies environment for the pharmaceutical supply chain in China, and reviewed the process, characteristics and problems of the main stakeholders of the current pharmaceutical system in China. We found that the deficiencies of the pharmaceutical market were caused by the ineffective supervision of drug regulation authority, distortion of the price schedule for medical services and pharmaceutical services, unreasonable mark-up pricing pattern for drugs and the lack of authoritative drug lists for health insurance schemes. Having taken into account all the factors discussed, higher-than-cost drugs preferred by all suppliers, including manufactures, wholesalers, hospital pharmacies and retailers can be diagnosed as the root cause of the market and government failures.National Essential Medicines System can contain the escalation of pharmaceutical expenditure, relieve the disease burdern of society and public, and guarantee the equity of essential medicines. But its implementation should also consider the regulation of the selection of essential medicines, pricing, production, distribution, rational use and reimbursement. It should be organized by the government. National Essential Medicines System needs to take into consideration different private and social stakeholders'objectives to make sure essential medicines are available within the context of functioning health systems at all times in adequate amounts, in the appropriate dosage forms, with assured quality and adequate information, and at a price the individual and the community can afford.China's Ministry of Health has issued a list of 307 essential drugs as part of its plan to create an essential medicine system in 2009. Then Minstry of Human resource and Labour and Social Security regulated that all medicines included in the list would be deemed reimbursable by all health insurance schemes. The study compared the latest version of Essential Medicine lists of China and the World Health Organization Model list of Essential Medicines so as to provide the suggestions and evidence for the selection, adjustment, revision, and implementation of the Essential Medicine lists of China. The total numbers of Essential Medicine list of China is much less than that of WHO list, with half of the identical medicines.With the development of health insurance of China and in the field of pharmacology and pharmaceutics,China should increase the number of the essential medicines, specify the dosage and the route of administration, cooperate with other institutions, such as Committee of Family Planning and Centers for Disease Control, to select the essential contraceptives and vaccines. It is necessary to improve a comprehensive and authoritative of National Essential Medicine lists by integrating different lists or formularies to fully play its due role.Delphi and Analytic Hierarchy Process methods were employed to evaluate the relative significance of the five principles in the selection of national essential medicines. The five principles are the need of prevention and treatment, evidence on efficacy and safety, reasonable price, convenient routes of adminstration, and integration of traditional Chinese medicine with Western medicine. Those principles have been widely accepted. But they play different roles in the selection of national essential medicines. The relative weights of the ive principles are 0.227, 0.323, 0.219, 0.118, and 0.063, respevetively. It is also found that compared with the other four principles, integration of traditional Chinese medicine with Western medicine has not been paid enough attention. It is easily neglected. The results suggested traditional Chinese medicine and ethnic medicine shoulb be further developed and modernized and be given priority in the selection of national essential medicines.To identify and weigh the various criteria for the selection of essential medicines, and to explore the quantitative method of the selection, conjoint analysis and discrete choice experiment were employed. A wide range of criteria were mentioned, and summerrized in six categories: Disease prevalence, Severity of disease, Age of target group, Routes of administration, Individual health benefits, and Cost-benefit. On the basis of six criteria, a questionarie of multi-criteria decision on national essential medicines was composed. The survey was conducted among health related staff. The results showed that those criteria have statistically significant influence on the choice of the essential medicines.This research has shown the feasibility of simultaneously accounting for efficiency, equity, and social concerns in selection or preference of the essential medicines. By showing the relative importance of the different criteria, decision makers can clearly see the implications of the tradeoffs between different concerns.
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