| BackgroundChina start-up new medical reform in 2009, in the aspect of medicine, it claimed establishment of essential medicine system, to security the demand of essential medicine. Based on this background, China’s essential medicine system was formally established in August,2009.To improve the accessibility of essential medicine is the prominent goal of essential medicine system. As the important aspect of accessibility, the availability of essential medicines is extensively researched in China. However, these studies mainly from the perspective of supplier, as facilities the breakthrough point, to study the availability through analyzing the purchase, allocate and supply of essential medicine in various kinds of medical institution, especially in primary health care institution. The study of availability from the perspective of agent is hard to reflect the use extent, which is the availability of essential medicine. The studies of availability of essential medicine from the perspective of demander and analyze the percentage of residents’ medicines from the essential medicine list are few. Based on this background, this study from the perspective of demander, to discuss the availability of essential medicine and existed problems via investigating the medicines of rural residents in three counties in Shandong province and analyzing the percentage of residents’medicines from the essential medicine list and purchase system distribution, which have theoretical and realistic significance to perfect the essential medicine system and improve the availability of essential medicine of rural residents.ObjectiveTo understand the use extent and availability of essential medicine of rural residents through household survey, investigating the medicines of rural residents and measuring percentage of residents’ medicines from the essential medicine list.MethodsThis study adopt literature analysis, key informant interview and field survey. In field survey, we use stratified sampling and selected three counties, which are A, B and C as study sample area according to the degree of economic development and geographical position. Then we selected three towns each county and selected two villages each town. We selected 902 households from 18 villages at last. We studied the availability of essential medicine of rural residents in Shandong province through surveying the medicines bought by these residents of 902 households.Main results1 The availability of essential medicine of rural residents in generallyAs a whole, the proportion of essential medicine of all medicines that residents bought is 64.36%, there is still 35.64% of medicines are not essential medicine.From the perspective of region, the proportion of essential medicine of all medicines that residents bought in county B is lowest (60.69%), and county C is largest (67.28%). From the perspective of income, the proportion of essential medicine of all medicines is largest (67.45%) in low income group and lowest (62.01%) in high income group. We analyze the top ten non-essential medicines of all medicines that residents bought, and found these non-essential medicines are mainly cold medicines and hypertension medicines2 The availability of essential medicine of rural residents that bought from a variety of agenciesIn terms of agencies, the proportion of essential medicine that bought in county hospitals is lowest(55.67%), and that proportion is largest (72.02%) in township hospitals, and then is the village clinics (70.91%), but there is a certain distance away from the policy regulation, because essential medicine system claims the primary health institution provide essential medicine only.In terms of regions, the proportion of essential medicine that bought from county hospitals of rural residents in county A and in county B is lowest (50.61%and 49.57%), and the proportion of essential medicine that bought from village clinics of rural residents in county A is largest (76.40%). The proportion of essential medicine that bought from township hospitals of rural residents in county B and county C is largest (70.83% and 79.25%).In terms of income, the proportion of essential medicine that bought from township hospitals is lowest (75.00%,71.91% and 71.93%) in three income group and the proportion of essential medicine that bought from county hospitals is lowest (58.75% and 55.00%) in low income group and in middle income group. The proportion of essential medicine bought from pharmacy is lowest (49.30%) in high income group.3 The availability of essential medicine of different kinds of diseases of rural residentsThe difference of availability of essential medicine of different kinds of diseases is large, the availability of essential medicine that treats chronic disease such as hypertension and diabetes is well, but the availability of essential medicine that treats cold is bad. The proportion of essential medicine treats heart disease, diabetes and hypertension (85.90%,83.76% and 77.65%) are largely higher than that proportion of essential medicine that treats cold (44.37%).In term of regions, the proportion of essential medicine that treats diabetes of all medicines of rural resident in county A and county C is largest (91.18% and 87.50%), and the proportion of essential medicine that treats heart disease of all medicines of rural resident in county B is largest (84.14%).In terms of income, the proportion of essential medicine that treats cold is smallest (48.53%,39.75% and 48.84%) of rural residents in all income groups. The proportion of essential medicine that treats hypertension, diabetes and heart disease is largely higher than that proportion of essential medicine that treats cold of rural residents in all income groups.Conclusions and recommendationsThe availability of essential medicine of residents in Shandong province is poor, and varied in agencies and category of diseases. The availability of essential medicine from township hospitals and village clinics are higher than the availability of essential medicine from county hospitals and pharmacies. In terms of category of disease, the availability of essential medicine varied in different kinds of diseases, the availability of essential medicine of chronic disease, such as diabetes and hypertension is well, but the phenomena of shortage of essential medicine of common disease is serious, the availability of these essential medicine is poor. In order to improve the availability of essential medicine of rural residents, this study put forward the following policy suggestions:1 Increase primary health personal participation of formulation and adjustment of essential medicine list.2 Strengthen evaluation of utilization of essential medicine list and adjust the list according to actual situation.3 All sorts of agencies’priority is allocate and utilize essential medicine.4 Insist the centralized bidding system of essential medicine and regulate purchase behavior of primary health care institutions. |
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