Evaluation Of The Free Medicine Policy For Poor Patients With Hypertension In Rural Areas Of Shandong Province

Among hypertensive patients founded in 2007 baseline survey, a considerable proportion of the patients are very poor. These hypertensive patients can not afford drugs for treatment or did not have standardized treatment because of poverty. As a result, the management, treatment and control rates of these cases still maintained at a relatively low level. These diseases have seriously affected the physical and mental health of these patients and their normal life.In 2008, the subproject provided free medicine for the patients in indigent families and conducted standardized treatment and management for the patients in order to decrease the risk of complications and then to improve the quality of their life. The objective of the subproject is to construct a proper system to provide free medicine to the impoverished patients in rural areas and to propose a model that is fit for the standardized management of the poor patients with hypertension.Main objective:Analyze the specific implementation process of the subject thoroughly to draw some experience and lessons from the project and evaluate the impact of the program.Methods:Based on the economic status, eight counties in Shandong province were chosen. In each county, two towns were chosen and then at each town two villages were chosen, both randomly. All the patients with hypertension who are covered by free medicine policy were included in the survey. At the same time,241 patients who did not accept free medicines were considered as control. In addition, key information interview was applied to realize the implementation of the project. The qualitative materials were analyzed by summarizing note an records. Quantitive data was described by mean and median, while categorical data was described mainly by rate and propotion. T-test was used for the comparison of two groups with quantitive data of normal distribution; chi-square was used for unordered data and rank test for ordinal categories and quantitive data which was not nrmal disturibution. Additionaly, propensity score matching was applied to balance the difference between the treatment and the control group.The main results:1) Only one patient who accepted the intervention of none-NAH did not take any drugs for hypertension, while there were twelve patients in the control group. The proportion of patients covered by none-NAH intervention taking medicines regularly was much higher than patients in the control group.2) The median of out of pocket payment of patients in the none-NAH group was 20 Yuan which was lower than the control group (240.5 Yuan).3) The blood pressure level of none-NAH group was almost equal with the control group.4) All patient of NAH group took some drugs for hypertension, while there were fifteen patients (14.7%) in the control group did not take any drugs. The proportion of patients covered by NAH intervention who took medicines regularly was much higher than patients in the control group.5) The median of out of pocket payment of patients in the NAH group was 12 Yuan which was lower than the control group (228 Yuan).6) The blood pressure level of NAH group was lower than the control group, but there was not statistical significance.7) The degree of satisfaction of patients covered by free medicine policy was above 95%.Conclusion:1) Patients covered by free medicine policy were more likely to take medicine regularly and the free medicine policy was useful to solve the problem of low-compliance caused by payment difficulty.2) Free medicine policy can help reduce the economic burden of poor patients with hypertension.3) The free medicine policy was not effective for the control of blood pressure and there were some problems in the implementation of the program.4) Most patients covered by the program were satisfied with it.Policy recommendations:1) Strengthen the management of hypertensive patients and to increase the control rate. One way is to manage patients in three levels and another way is to build health record that can really reflect the health status of patients.2) Pay much more attention to the prevention of hypertension but not just treatment. Make the knowledge of hypertension prevention more available; set facilities for sports; reinfore the training of village doctors and students in school.3) Improve compliance of hypertensive patients. For old patients, the type of medicine can not be too complicate or else the drugs should be of diffent color or size; educate patient to develop a habit, such as always taking drugs before or after meal, to figure out the problem of forgetting; village doctors should know the mecheniam of drugs and can explain it to patients; educate patients and change their wrong concept and behaviors.4) Intensify the training of village doctors to make sure that they can make correct decisions for patients.5) Make sure fund for the program can be in place timely and find a long-term way to compensate poor hypertensive patients to ensure that they can still be treated adequately when the project is over.6) Pay village doctors who were in charge of the program so that they can finish the program work with much more patience. Hence, patients can get much more benefit from the program.7) Emphasize the supervision of the program to make sure the program was implemented completely according to the project.