| BackgroundEssential medicines are the drugs that can meet the basic health needs, with suitable dosage and form, reasonable prices, secure an adequate supply, and the public can get fairly. Drugs make good sense for maintain health and save lives as a special commodity, so it makes great significance to study the accessibility of essential medicines. Accessibility of medicines means that everyone can get medicines with quality assurance at affordable prices and these medicines are properly used. Access to medicines is an important guarantee to the access of health services and is the basic premise of the goal "Health for All". Now the accessibility of essential medicines is in a low level in Chinese and the irrational use of the medicines is very serious, which have an impact on raising the level of people’s health. To protect the people’s usage of medicines and reduce the patients’burden of medical and health care, we established a national essential drug system in2009year, which give full play to the role of market mechanisms with the government’s macro-control, and the medicines are purchased by public bidding and uniform distributed to reduce the intermediate links of the purchasing and distribution of essential medicines and request all of the government organized grass-roots health care institutions to equip and use of essential medicines, protecting the accessibility of essential medicines in rural areas. Since the implementation of essential drug system, the bidding rate of essential medicines was at a high level, the prices of essential medicines was decreasing sharply and improved the affordability of patients’ medicines and health services, and finally the accessibility of essential medicines was improved, but the quality and use of essential medicines should cause of concern. Some pilot areas of Shandong province began to implement essential medicine system from March2010, the primary health care institutions government-run in25districts and rural health service agencies in27counties/cites first. There is no unified regulation about whether village health clinics implement essential medicine system. This study investigates the bidding, distribution, equipment and usage of essential medicines of Shandong province after the implementation of essential medicine system, to study the current situation of essential medicines in rural areas of Shandong province.Study ObjectiveThe objective of this study was to analyze the availability, affordability and rational use of medicines through investigate the bidding, distribution, equipment, price and usage of essential medicines in rural areas of Shandong province after the implementation of essential medicine system, to improve the accessibility of essential medicines in rural areas and provide some relative policy advice for improving and spreading the essential medicine system further.Study MethodologyIn this study, according to the implementation of essential drug system in Shandong province, with considering the geographical distribution and socio-economic conditions, we selected Jiaonan city, Linzi district and Ningyang county from the first pilot counties, and selected three township hospitals randomly from the three counties, then we investigated and researched the equipment, price and usage of essential medicines of each township hospital, and chosen outpatient prescriptions of each township hospital for this study, selected3189prescriptions totally, and3097prescriptions totally were included and analyzed. This study also analyzed the amount, quality and the distribution timeliness of essential medicines through the data from the centralized medicine procurement centers of Shandong province. In addition, the study also interviewed the county health executives, managers of township hospitals, doctors and distribution enterprise, finally, we interviewed38people in all.Both quantitative and qualitative analysis methods were used in the study, the study mainly used descriptive analysis, analysis of variance (ANVOA), and the standardized price survey from WHO/HAI to analyze the quantitative data, and the qualitative data mainly used the thematic inductive method to collect and analyze.Study results1) The availability of essential medicines in rural areas of Shandong provinceThe bidding rate of essential medicines is high, but the quality of essential medicines was generally low. There were463species essential medicines won the bid in Shandong Province, including280drugs of national essential and183drugs of Shandong province addition, the bidding rate reached91.21%and87.14%, respectively, more than half of essential drugs produced by manufacturers of400ranked behind.Now the total arrival rate of essential medicines of distribution in Shandong Province was in a high level, reaching98.20%, the three-day arrival rate level was low, only58.28%. This study was to analyze the status of distribution of essential medicines from different dimensions, the timely delivery of essential medicines in areas with high levels of economic development was better than the areas of economy backward; the timely delivery of essential medicines of distribution enterprises in Shandong province is better than distribution out of Shandong province; the more the distribution monetary, the faster the timely delivery of essential medicines.The equipment of essential medicines in rural areas of Shandong province was in a low level, the proportion of the number of national essential drugs accounted for the national essential drug list was48.86%, the proportion of Shandong province addition drugs was34.76%.Whether national essential medicines or Shandong province addition medicines, the utilization rates was low. The utilization of national essential medicines in three sample counties was70.22%, and the Shandong province addition medicines was16.92%. In the three sample counties, the utilization rate of essential medicines in Jiaonan city was higher than the other two counties, and Ningyang county’s utilization rate of Shandong province addition medicines was the most.2) The affordability of essential medicines in rural areas of Shandong provinceAfter the implementation of essential drug system, the price of essential medicines declined compared to the previous. Part of the commonly used medicines were selected in this study and compared with the international reference price, discovered that the prices of7out of21species medicines was higher than the international reference prices, the prices of someone was16times more of the international reference prices, the prices of some essential medicines in rural areas of Shandong province still higher than international reference prices.In this study, we selected the average annual per-capita net income and subsistence allowance standard of rural residents in Shandong province as reference standards and analyzed the affordability of essential medicines, found that as opposed to the per-capita net income of rural residents in Shandong province, the affordability of essential medicines was in a good condition, but to the subsistence allowance standard of rural residents in Shandong province, under the standard treatment, the cost of4out of16species medicines beyond the daily subsidy standards, the affordability of low-income group still weak.We analyzed the outpatient prescriptions of township hospitals and found that the median cost of a single prescription is23.5yuan, lower than per-outpatient drug cost (30.29yuan)of township hospitals from Statistical Bulletin of health service in Shandong province,2010>, the patients’burden of medical and health services has abated.3) The rational use of medicines in rural areas of Shandong provinceNow the phenomenon of irrational use of medicines was serious in rural areas of Shandong Province, injections and antibiotics over used, and there were still "excessive prescriptions". We analyzed the outpatient prescription of the three sample counties in Shandong Province and found that antibiotics and injections utilization ratio were49.56%and37.29%separately, far exceeding the reasonable standard developed by the WHO, and analyzed the number of medicines of a single prescription and found that4.33%prescriptions have5species medicines more, which reflected the phenomenon of "excessive prescriptions" issued by some doctors still exists.Study conclusion1) After the implementation of the essential medicine system, the bidding rate of essential medicines in rural areas of Shandong province was high, which can ensure the availability of essential medicines, but quality of essential medicines is in a low level overall;2) The total arrival rate of essential medicines was high, but the third-arrival rate is low due to there is no coherent payment mechanism of new cooperative medical care funds and returned money mechanism of essential medicines;3) To the most people in rural areas, the affordability of essential medicines is in a good condition, but to the low-income groups, the affordability is still heavy relatively;4) Irrational use of essential medicines is widespread.SuggestionsAiming at the status of the accessibility and usage of essential medicines in rural areas of Shandong province, we make the following suggestions:1) Give full play to the leading role of the government, ensure the financial investment and strengthen effective supervision and management of pharmaceutical production, distribution and usage.2) Under the existing system of the bidding and distribution of essential medicines, pay attention to the harmonization of relevant policies, strengthen the publicity of essential drugs, to ensure the accessibility of essential medicines with quality assured.3) Scientific calculate and reasonable fare the price of essential drugs, and focus on the affordability of essential medicines for low-income group in rural areas.4) Strengthen learning and training the knowledge on rational use of medicines to primary care practitioners and patients, establish a healthy concept of rational use of medicines, and intensify the supervision and management to the usage of medicines in the countryside. |
PDF Full Text Request