Research Of The Quantitative Evaluation Model Of Essential Medicine System From The Public Perspective

[Objective]To combing the conceptual framework that built the essential medicine system and design the quantitative evaluation model of essential medicine system from the public perspective, evaluate the essential medicine policy in recently medical and health system reform (2009-2011), compare the difference of essential medicine system in different provinces and analyze the causes and provide a basis for further perfection and improvement of the current essential medicine system policy.[Methods]Understanding and analysis of the status, main problem and indicators of investment, operation, output, effect, environment of the essential medicine system analysis of primary care health institutions through documentary research, expert advice and other methods, and build a conceptual framework of essential medicine system, as well as the costs and benefits estimation model. And the use of drugs and health system focus on the implementation of the program (2009-2011), of the data, estimates the total cost, total benefit, cost-effectiveness of the implementation of essential medicine system in our country as a whole, and primary health institutions in provinces, using the data of a mid-term evaluation of program of the focus on the implementation of the health system reform. Analyzing the relevant factors of the total cost, total benefit, cost-effectiveness of the implementation of essential medicine system in primary health institutions in provinces through univariate analysis.[Results]1. Essential medicines concept model includes four sections:inputs, outputs, effects, environment. Inputs includes physical inputs and intangible inputs. The physical inputs include investment in human resources, capital investment and infrastructure investment in three parts; the intangible inputs include five sections:the policy investment, investment in education, investment in management, political involvement, and investment in promotion. Outputs include system outputs and entities outputs. The system outputs include the introduction of the Essential Drugs List and other relevant supporting policies. Entity outputs include production, procurement, distribution, use and supervision of essential medicines. Effects comprise economic effects, health effects, and new mechanism effects. The environment section is divided into the natural conditions and policy conditions. Natural conditions refer to the local infrastructure conditions, and policy conditions refer to the relevant health policy and fiscal policy.2. Building quantitative evaluation model of essential medicine system.(1) Computable total cost=subsidies of the gaps of recurrent balance of payments of primary medical institutions implementing essential medicine system (including pay for performance policy and local self-serving service personnel wage subsidy policy)+expenses for tender, procurement of essential medicine+training funds of essential medicine system;(2) Adjusted computable total cost=Computable total cost*(1+the annual lending rate);(3) Total benefits=primary care outpatient cost savings due to increased affordability+secondary hospital outpatient costs savings due to increased availability+primary care inpatient cost savings due to increased affordability+benefits of reduced loss of productivity due to increased degree of rational use of drugs3. Jiangsu, Shangdong and Anhui province have higher cost in implementing essential medicine system, while Tibet and have lower cost. Provinces that have higher total benefit in implementing essential medicine system include Zhejiang, Guangdong, Jiangsu and Shandong, while the lower ones include Shaanxi, Qinghai and Inner Mongolia. Zhejiang, Guangdong have higher cost-effective provinces, the lowest two provinces are Shaanxi and Gansu.20provinces have negative cost-effectiveness, only nine positive4. The total computable cost of essential medicine implementation is￥14,366,880,000, the total benefits is￥15,013,280,000, and cost-effectiveness is￥646.4million5. Relevant factors of the total benefit of the implementation of essential medicine system in different provinces include Regional economic development status(GDP/per capita GDP), population status, the compensation situation of primary health care institutions (the proportion of fiscal spending accounting for total revenue of primary health care institutions), construction of primary health care institutions (compliance rate of township hospitals, community health service center compliance rate), archiving rate of residents electronic health records, and total cost. The total cost is associated with the regional economic situation and population. The cost-effectiveness is only associated with the regional economic situation.[Advice]1. Policy recommendations on improving the current essential medicine system:(1) Adjust the addition policy of essential medicine system;(2) Take measures to motivate a doctor’s prescription of essential medicines, and change the current policy of mandatory use;(3) Improve the bidding policy of essential medicine, reflecting the priority of quality and reasonable price;(4) Give a reasonable profit to distribution enterprises to encourage circulation enterprises bigger and stronger.2. The current quantitative evaluation model still needs further improvement, but it brings new ideas and overture to the system. It is proposed that not only the effectiveness but also the cost needs to be evaluated when analyzing the effect of the system3. Local economic conditions had a significant impact on the essential medicine system effectiveness. It is recommended that the local governments should continue to strengthen the economic construction. While developing livelihood projects In the design of the system, economic characteristic of different regions must be considered to develop differentiated essential medicine policies. The input of essential medicine system has limited effect on the effectiveness, other factors such as economy and population, financial compensation and hardware construction, as well as the residents health record need to be considered.4. Further research on system positioning, directory selection, bidding, price management, use policy is needed to implement essential medicine system in public hospitals[Innovation and Limitation]1. Innovation:(1) There is a quantitative evaluation of economics on a whole public system innovatively in this study. It opens up a new way of thinking for future evaluation system. Evaluation need not only consider the effect, but also consider the implementation of the system costs.(2) This study conducted a comprehensive calculation and analysis in inputs, status, output, problems, effects, benefits, environmental of the system, and based on the results presented next perfect system of essential medicine policy recommendations.2. Limitation:(1) Since the study is the first attempt to quantify the economic evaluation of the system, it is inevitable that there is not quite reasonable in the establishment of economic evaluation model.(2)There is a time course from establishing the system to getting the effect. Due to data limitations, this study only evaluated quantitatively implementation of the essential medicine system of one year to the cost-effectiveness, there may be some benefits of established system that have not fully realized.