The Study On The Accessibility Of Essential Medicine In Township Hospitals In Shandong Province

Objective In this paper, quantitative and qualitative methods were used to analysize the accessibility of essential medicine from the supplier entities, demand entities and administrator perspective systematically, involving the availability, affordability and rational use of essential medicine before and after the NEMS has been implemented. To discuss the difference of the accessibility of essential medicine at all different counties of economic development levels.Then to assess the accessibility of essential medicine comprehensively and carry out comparative study internationally. And on this basis, to discover the obstacles that affect the availability, affordability and rational use of essential medicine in township hospitals. Then make suggestions to promote the accessibility of essential medicine.Methods Facilities were selected using a multistage stratified random sampling method in this research. WHO/HAI analysis standard method was used for reference. Literature review and focus group discussion were used to determine the evaluation index of availability, affordability and rational use of essential medicine. To describe the index of accessibility from the supplier entities, demand entities and administrator perspective. Using comprehensive index and clustering analysis to assess the accessibility of essential medicine comprehensively in 11 counties, involving availability, affordability and rational use of essential medicine. On the whole, the cube model was used to assess the accessibility of essential medicine before and after the NEMS has been implemented and to compare internationally. Quantitative and qualitative methods were used, involving grounded theory and path analysis, to recognize the factors that affect availability, affordability and rational use of essential medicine in township hospitals. Then stakeholder analysis was used to generalize the stakeholders.Results After the NEMS has been implemented, the issue rate, the general arrival rate, the arrival rate in three days of essential medicine, the percentage of equipping essential medicine, the percentage of medicines prescribed from the National Essential Medicine List per prescription and the percentage of prescriptions containing essential medicine have risen obviously than ever before. The arrival rate in three days was 60.32%, and the percentage of medicines prescribed from the National Essential Medicine List per prescription was 73.91%, which indicated that these indexes were at a lower level. The accessibility of essential medicine in 11 counties was at a mid to upper level. The average MPR of common medicines has decreased from 3.71 to 3.04, and the average price of essential medicine was at a low level. For common-paid people, one monthly treatment for diseases cost 0.70 day’s wages before the NEMS has been implemented, and after the implementation of the NEMS, the cost was 0.29 day’s wages. For the lowest-paid people, it cost 2.53 days’ wages before the implementation of the NEMS, and after the NEMS has been implemented, it was 1.07 days’ wages. Meanwhile, the affordability of essential medicines in 11 counties has been improved after the implementation of the NEMS, and it was at a medium level. After the NEMS has been implemented, the average number of medicines per prescription, the percentage of prescriptions containing antibiotics, the percentage of injection prescriptions, the percentage of medicines prescribed by generic name and the percentage of medicines prescribed from the National Essential Medicine List has risen sharply, and overall it was at a mid to upper level. The score in the accessibility of essential medicine after the implementation of the NEMS, has risen from 0.17 to 0.50 through evaluation analysis. Through combining grounded theory, path analysis with stakeholder analysis, stakeholders that affect the accessibility of essential medicine in township hospitals involved the governments and relevant administrate departments, medicine manufacturers and distributors, township hospitals, doctors, as well as rural residents.Conclusions After the implementation of the NEMS, for the availability of essential medicine, the situation has been improved, while there was untimely arrival rate and unwillingness utilization. The price of essential medicine has declined, while it was also higher than WHO standard. The affordability has been improved, while for the lowest-paid people, the cost burden was still higher. The indexes evaluating the rational use of medicines have also increased, but to compare with the average level of developing country and the international standard, it did not go far enough. The data triangulation revealed that the results of objective data research matched up the results of quantitative and qualitative research to the doctors, rural residents and administrators. But the effect of the NEMS was not obvious for the rural residents.Overall, the accessibility of essential medicine has been improved, but it was not enough. Thus, strategy from selection, manufacture, distribution, utilization, pricing, reimbursement and supervise will enhance the availability, improve the affordability and promote rational use of essential medicines.