School of Public Health, Fudan University, Shanghai, PR China.
J Med Econ. 2013;16(2):289-94. doi: 10.3111/13696998.2012.751176. Epub 2012 Dec 7.
To analyze the achievements, issues and policy recommendations for implementing essential medicine system in China after a 3-year effort.
Policy documents analysis and Literature reviews are conducted.
From 2009-2011, a series of national essential medicine (EM) policies has been established which contain EM list, organizing production, quality assurance, pricing, tendering and procurement, distribution, rational use, monitoring and evaluation, etc. About 98.8% government-run primary healthcare institutions and 41.5% village health posts are conducting zero-mark-up policy while buying EMs. The average cost per visit, per admission, and per description in outpatient and inpatient departments has declined. The issues with the national EM list cannot meet the requirements of clinical practice at the local level, all provinces have to increase additional 64-455 EMs in their local supplementary list; the limitation of EML in primary healthcare institutions causes patients to transfer directly to secondary or tertiary hospitals to search appropriate treatment; there is no defined regulation or legislation regarding the responsibility and accountability of government to compensate for the financial loss after implementing a zero mark-up policy in primary healthcare institutions. In the future, some innovative reform should be taken into account, such as revising EML, quality assurance, control margins within the distribution system, differential pricing and internal reference-based pricing, waive taxes and import duties of EMs, and separation between prescribing and dispensing in public hospital reform.
Establishing a national essential medicine system is a difficult task to accomplish. The role of the zero-mark-up policy of EMs is to cut off the economic profit chain among different stakeholders. Using pharmaceutical profit to subsidize hospital revenue will be gradually eliminated in China.
分析中国实施基本药物制度 3 年来的成效、问题及政策建议。
政策文件分析和文献回顾。
2009-2011 年，建立了一系列国家基本药物政策，包括基本药物目录、组织生产、质量保证、定价、招标采购、配送、合理使用、监测评价等。约 98.8%的政府办基层医疗卫生机构和 41.5%的村卫生室按进价实行零差率销售基本药物。门急诊和住院次均费用下降。国家基本药物目录存在的问题不能满足基层临床实践的需要，各省均需在省级补充目录中增加 64-455 种药物；基本药物在基层医疗卫生机构的局限性导致患者直接转诊到二级或三级医院寻找合适的治疗方法；对于实施基层医疗卫生机构零差率政策后政府补偿医疗机构经济损失的责任和义务，尚无明确的规定或立法。未来，应考虑进行一些创新改革，如修订基本药物目录、质量保证、控制分配系统内的利润空间、差别定价和基于内部参考的定价、免除基本药物的税费和进口关税，以及在公立医院改革中分离处方和配药。
建立国家基本药物制度是一项艰巨的任务。基本药物零差率政策的作用是切断各利益相关方之间的经济利益链条。利用药品利润补贴医院收入的做法在中国将逐渐被淘汰。
