| Objectives:To evaluate the implementation status of the Essential Medicine System(EMS)in public and private Community Health Service Centers(CHS Centers)in Nanchang.To assess effect and to spot problems of implementing EMS in public and private CHS centers,thus to suggest effective approaches to improve its implementation.Methods:Literature review,general investigation(quantitative research)and semi-structured interview(qualitative research)were utilized in this study.General investigations were conducted in all public and private CHS centers in Nanchang;Interview was conducted in 2 CHS centers in relevant directors of Health and Family Planning Commissions,relevant directors and health care workers of CHS centers.Quantitative research was general investigation in all the CHS centers using self-designed questionnaires.Qualitative research was carried out in the form of semi-structured interview,aiming at collecting data required by following general investigation and making on-site evaluation of the operation of CHS centers.Quantitative data were entered in to database created by Epidata 3.1.SPSS 18.0 was utilized in data clear-up and statistical analysis.Qualitative data were recorded and analyzed by Excel 2013,analyzing the implementation status of Essential Medicine System and identifying problems in execution.Results:1.Policies on EMS implementation in public and private CHS centersAt the beginning of formulating national EMS related policies,only relatively clear provisions about how to implement EMS were made for public centers;while how to implement EMS,whether medicine should be purchased through online bidding and how to compensate CHS centers were not clearly defined for private centers.In particular,the problem of how to implement the zero-profit drug sales policy in private centers were not clear in the documents,causing development imbalance between public and private centers.With steady progress of EMS in public centers,both national and Jiangxi provincial policies on EMS implementation in private centers were issued.But certain differences still exist between public and private centers in terms of the scope of implementation of EMS,procurement of essential medicine,usage of medicine out of essential medicine list,institutional compensation and HCWs' incentive.2.Effect of EMS implementation in public and private CHS centers(1)Contrast between public and private CHS centers after EMS implementation: From 2012 to 2014,84.6%,81.5% and 92.6% public CHS centers in Nanchang carried out zero-profit drug sales centered EMS;All centers were covered with financial compensation by government and over 65% centers purchased medicine through bidding.92.3% private centers started to implement EMS in 2014,among which 61.8% got financial compensation from government and 46.2% centers purchased medicine through bidding.(2)Financial status: In the past 3 years,total income saw a slight decline(average annual growth rate-1.66%)in Nanchang public centers,while total income in private centers increased steadily(average annual growth rate 18.03%).Medical expenses accounted for the majority of total expenditures of public and private centers.Nanchang public CHS centers' government subsidies represent a large proportion of their total revenue,but the absolute value and proportion in total revenue were declined.For private centers,medical incomes were the main source of total revenue;Government subsidies' proportion was low but was on the rise.Nanchang public centers had cash surplus but the amount had a noticeable decline(annual growth rate-50.08%),while private centers' surplus were on the rise(annual growth rate37.79%).From 2012 to 2014,all public centers in Nanchang had drug cash surplus,but the number was relatively small.In 2014,Drug income in Nanchang private centers accounted for 68.65% of total income,and had a 202.4 thousand surplus,which were higher than the numbers for public centers(51.69%,53.3 thousand,respectively).(3)Medical service utilization: Nanchang public centers' medical service utilization increased steadily,while private centers declined slightly.In 2014,Outpatient & emergency department visits and inpatient visits in public centers were higher than that of private centers.Private centers' average outpatient & emergency department visits was 34175 with annual growth rate of-2.23%,and was lower than thar of public centers(35053,24.09%).Average growth rate of Nanchang private centers' inpatient visits(-0.62%)was lower than that of public centers(10.09%).(4)Income of health care workers(HCWs): HCWs' income in private centers was lower than those official staff in public centers,but was higher than those contracted staff.In terms of average annual growth rate,income of HCWs in private centers(9.68%)was higher than that of official staff(4.84%).(5)Average expenses of outpatient & emergency department visits and inpatient visits: The average expenses of inpatient visits and medicine expenses of outpatients in private centers were higher than average expenses in public centers.Average expenses of inpatient visits and inpatient medicine expenses in private centers were on a downward trend(annual growth rate-11.50,-11.86%),while the numbers of public centers increased(annual growth rate 18.39%,8.06%)(6)Essential medicine supply: Essential medicine supply rate in private centers was much lower than public centers.In 2014,essential medicine supply rate in public centers(46.34%)declined,while utilization rate(54.41%)in public centers increased;Both essential medicine supply rate in(17.07%)and utilization rate(14.94%)in private centers were on the rise.(7)Rational Use of medicine: From 2012 to 2014,usage rate of antibiotics in public centers were lower than that of private centers.In the past 3 years,private centers' average outpatient prescriptions and average antibiotic prescriptions were higher than those of public centers.Conclusions:1.Policies on zero-profit sales of essential medicine in private CHS centers should be issued to make the use of essential medicine,government subsidies,and essential medicine reimbursement detailed and implemented,thus reducing the gap between public and private centers,and benefiting the public.2.Public centers had a little cash surplus while some private centers had poor operation in the past 3 years.Although public centers implemented EMS,they had medicine income balance and their total revenue were not significantly different compared with those centers without EMS.After implementing EMS,public centers' government subsidies accounted for relatively high proportion including basic public health service subsidy,essential medicine special subsidy,etc.Medical income was the main source of total revenue in private centers,while government subsidies' proportion in total revenue was relatively low.Private centers had low willingness to utilize essential medicine and had a lower rate of essential medicine supply compared with public centers.3.In general,implementation of EMS promoted rational usage of medicine;Private centers without EMS had a poor condition of rational medicine use,and proportion of centers with irrational medicine use was not significantly changed. |
PDF Full Text Request