List Of Essential Medicines In China And Its Implementation Status

BackgroundNational Essential Medicine Policy is an important part of Public Health Policies. From firstly participating the essential medicine plan of World Health Organization (WHO) at1979to establish our National Essential Medicine Policy at2009, the development of Essential Medicine in China have experienced over30years. Despite lots of progresses have achieved during the amendment of Essential Medicine Lists (EML), there are some problems and defects, such as the selection of Essential Medicine, the diversities of additional lists in different regions, still needed to be modified. As a key component of National Essential Medicine Policy, the accurate and scientific features of EML will be directly influence the implementation effects. Therefore, the EML should be continuously amended and improved during the process of the medical system reform.ObjectivesThe objectives of the current study are to analyze Chinese EML and investigate the implementation status of EML in order to provide some suggestions to the further amendment and improvement of Chinese EML.MethodsThe present study mainly used the descriptive statistical methods, combined with references analysis and qualitative interviews to analyze the characteristics and implementation status of Chinese EML.1. Literature analysis:Searching and collecting literature of Essential Medicine development process and selective principles in China and other countries to learn from the modern and reasonable ideas and methods for utilization in Chinese EML.2. Descriptive Statistics:Comparative analyses of National Essential Medicine List(NEML) and Provincial Essential Medicine Lists(PEMLs) to the WHO2011Model List for chemical medicines and biological products; Comparative analyses of China National to the PEMLs for Chinese traditional medicines.3. Questionnaire survey and interview Results1. Comparative analyses of chemical medicine and biological product:(1) Several differences between the WHO Model List and China NEML were found, including list constitution, alignment of the classification, application scope and list selection.(2) There are145molecules on both the WHO2011Model List and China NEML.213medicines are only on WHO2011Model list but not on China NEML, including cancer therapies, other medicines used in hospitals.101medicines are only on China NEML, but not on WHO2011Model List. These are mostly cardiovascular, hormonal, gastrointestinal and anti-infective medicines.(3)657molecules are on China PEML in total,591molecules are on China PEMLs only.57molecules are with high province frequency greater than or equal to11/22. Part of these high province frequency medicines also are on the WHO Model List.275molecules are with province frequency only1/22.(4) China EMLs have long sections for chronic diseases including anti-infective medicines, cardiovascular medicines, analgesics, antipyretics, NSAIDS, anti-gout and DMARDs; cancer and palliative care; medicines affecting the blood and hormones, other endocrine medicines and contraceptives. Sections with most molecules appear on WHO Model list but not on China Essential Medicine Lists are anti-infective medicines; cancer and palliative care; cardiovascular medicines; hormones, other endocrine medicines and contraceptives.(5) Dosages of66molecules are supplemented in China PEMLs. Some of them also are on WHO Model List but not on China NEML.(6) Some molecules were removed from WHO Model list with reasons such as safety issue, low relative cost-effective or lack of clinical evidence but appear on China Essential Medicine Lists.(7) Since2002WHO has adopted compound medicines with restrictive criteria for inclusion based on evidence of safety and effectiveness. The compound medicines unique on China lists are mainly in the sections of anti-infection diseases.2. Comparative analyses result of Chinese traditional medicine shows that291molecules are supplemented on6China PEMLs.282molecules are on China PEMLs only,9dosages are dosage supplement.6provinces have ethnic medicine, which are Zhejiang, Guangdong, Qinghai, Gansu and Xinjiang.3. After the implementation of Essential Medicine, a series of effects have been achieved, such as medicine facilities tend to be reasonable in primary hospitals; the price of medicine tend to decrease; doctors have changed their prescriptive habits in the case of limited choices for selective medicine. Meanwhile, some problems also occurred, such as supplied medicine according to NEML could not always meet medical demands; doctors in primary hospitals only could treat limited and regular diseases.4. Suggestions for EML revision:the primary hospital often complaint with a limited Essential Medicine selection during the implementation of EML. Therefore, more medicines have been amended in PEMLs with broadly utilization and identified effects could be amended in NEML in the next round of revision; multiple dosages supplemented on China PEMLs should be taken into account in NEML revision; WHO Model List can be referred when modify NEML; medicines listed in only one province should be reviewed if could be replaced by more effective and cost saving medicines; many medicines for hospital care were supplemented in some provinces, these medicine using should be supervised to ensure their accessibility and availability.