National Center for Women and Children's Health, China Centers for Disease Control, Beijing, China.
Bull World Health Organ. 2013 Mar 1;91(3):184-94. doi: 10.2471/BLT.11.097998. Epub 2013 Jan 11.
To evaluate implementation of the National Essential Medicines Scheme (NEMS) in rural China.
Two rural counties/districts in each of three provinces where NEMS had been implemented were surveyed. Information was collected from NEMS staff at the province, county/district, township and village levels; patients with chronic disease were also interviewed. Service provision, finances, prescriptions, inpatient records and the expenditures of patients with certain diagnoses were investigated in township hospitals and village clinics. The results were compared with the corresponding data recorded before NEMS was introduced.
Following the introduction of NEMS, drug procurement in each study location was systematized. Total drug costs declined. This, and improved prescribing, reduced the costs of outpatient and inpatient care and led, apparently, to increased uptake of health services. However, the prices of some drugs had increased and the availability of others had declined. The compensation of health-care providers for NEMS-related reductions in their incomes had been largely ineffective. As a result of the introduction of NEMS, health facilities relied more on public financing. Many health-care providers complained about higher workloads and lower incomes.
Although it was well conceived, the introduction of NEMS into China's decentralized, fee-for-service system of health care has not been straightforward. It has highlighted the problems associated with attempts to modernize health care and health financing for patients' benefit. Sustainable mechanisms to compensate health-care providers for lost income are needed to ensure that NEMS is a success.
评估中国农村国家基本药物制度（NEMS）的实施情况。
在已实施 NEMS 的三个省份中，每个省份选择两个农村县/区进行调查。从省、县/区、乡镇和村各级 NEMS 工作人员收集信息；还对慢性病患者进行了访谈。在乡镇医院和村诊所调查了服务提供、财务、处方、住院记录以及某些诊断患者的支出情况。将结果与引入 NEMS 之前记录的相应数据进行了比较。
在引入 NEMS 后，每个研究地点的药品采购都实现了系统化。总药品成本下降。这一点以及处方的改进，降低了门诊和住院治疗的成本，并导致卫生服务的利用率明显提高。然而，一些药品的价格上涨了，其他药品的供应减少了。卫生保健提供者因 NEMS 相关收入减少而获得的补偿在很大程度上是无效的。由于引入了 NEMS，卫生机构更多地依赖公共资金。许多卫生保健提供者抱怨工作量增加和收入减少。
尽管 NEMS 的构思很好，但将其引入中国分散的、按服务收费的医疗保健系统并不简单。它突出了为了患者利益而尝试使医疗保健和卫生融资现代化所带来的问题。需要可持续的机制来补偿卫生保健提供者因失去收入而遭受的损失，以确保 NEMS 的成功。
