Li Qian, Chen Fei, Yang Min, Lu Liyong, Pan Jay, Li Xiaosong, Meng Qun
1 West China School of Public Health, Sichuan University, Chengdu, China.
2 West China Research Centre for Rural Health Development, Sichuan University, Chengdu, China.
Inquiry. 2018 Jan-Dec;55:46958018787057. doi: 10.1177/0046958018787057.
To increase use of medical service across the country, the Chinese government has tried to improve equity in health care access and reduce patients' medical expenses. For this purpose, the National Essential Medicine Policy (NEMP) was introduced in 2009 to mandate the distribution of medicines to health care facilities at a low cost and without profit. This study aims to evaluate the effect of the essential medicine policy on average per-visit expenses for outpatient and inpatient services. The annual national surveillance system data covering all the grassroots-level primary health care facilities (PHFs) in 2675 counties and 31 provinces in China during 2008 to 2012 were used in this study. The 4-level hierarchical random effects models were utilized to deal with possible dose-response effects of the policy and possible variations of such effects at the provincial, county, and facility levels. Our research findings suggest that the NEMP had positive effects in reducing both outpatient and inpatient expenses at grassroots level, and the policy effects tended to be greater as the exposure time increased. This study provides implications on reforming China's health system and its medicine cost control policies.
为了提高全国医疗服务的利用率，中国政府一直致力于改善医疗服务可及性的公平性，并降低患者的医疗费用。为此，2009年出台了国家基本药物政策（NEMP），规定以低成本且无利润的方式向医疗机构配送药品。本研究旨在评估基本药物政策对门诊和住院服务每次就诊平均费用的影响。本研究使用了2008年至2012年期间覆盖中国31个省份2675个县所有基层初级卫生保健机构（PHF）的年度全国监测系统数据。采用四级分层随机效应模型来处理该政策可能的剂量反应效应以及在省、县和机构层面这种效应可能存在的差异。我们的研究结果表明，国家基本药物政策在降低基层门诊和住院费用方面具有积极作用，并且随着政策实施时间的增加，政策效果往往更大。本研究为中国卫生系统改革及其药品成本控制政策提供了启示。
