Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, No. 38, Xueyuan Road, Haidian District, Beijing, 100191, China.
International Research Center for Medicinal Administration, Peking University, Beijing, 100191, China.
Int J Equity Health. 2018 Oct 19;17(1):158. doi: 10.1186/s12939-018-0870-5.
Essential medicines are those drugs that satisfy the priority health care needs of the population and help with functioning healthcare systems. Although many countries have formulated an essential medicine list, almost half of the global population still lack regular access to essential medicines. Research about the initiation of National Essential Medicines Policy in Chinese secondary and tertiary hospitals is inadequate, and the long-term effect on access after the reform is still unknown. This study's objective was to investigate the access to essential medicines in mainland China's secondary and tertiary hospitals.
Data on the access to 30 essential medicines from China's National Essential Medicine List were obtained from China Medicine Economic Information database covering 396 secondary hospitals and 763 tertiary hospitals. We improved the standard methodology developed by the World Health Organization and the Health Action International to measure the availability, median price ratio (MPR) and the incidence of catastrophic drug expenditure (CDE).
Five essential medicines had > 50% availability and the nationwide availability kept steady; availability of drugs in eastern regions of China was significantly higher than the central and western regions. The median MPR of 30 drugs nationwide kept steady approximately 5; MPR of drugs in the eastern regions was significantly higher than the central and western regions and the ratio of MPR of innovator brands to generics increased from 3.66 to 6.32 during the study period. The incidence of CDE caused by essential medicines decreased from 2011 to 2014; brand name medicines were more likely to cause CDE than generics and rural patients have a greater tendency to fall into CDE.
After the implementation of National Essential Medicines Policy, the MPR of essential medicines was well controlled and became more affordable in the context of steady availability. This has highlighted the problems associated with region disparity and inequity between rural and urban areas in the delivery of essential medicines and sustainable mechanisms are needed to deepen the National Essential Medicines Policy in mainland China.
基本药物是满足人群优先医疗保健需求并有助于医疗保健系统正常运行的药物。尽管许多国家都制定了基本药物清单，但仍有近一半的全球人口无法定期获得基本药物。关于中国二级和三级医院启动国家基本药物政策的研究不足，改革后对获得途径的长期影响仍不清楚。本研究旨在调查中国大陆二级和三级医院基本药物的可及性。
从中国医药经济信息数据库中获取了涵盖 396 家二级医院和 763 家三级医院的中国国家基本药物清单中 30 种基本药物的可及性数据。我们改进了世界卫生组织和国际健康行动制定的标准方法，以衡量可及性、中位数价格比（MPR）和灾难性药物支出（CDE）的发生率。
有 5 种基本药物的可及性超过 50%，全国范围内的可及性保持稳定；中国东部地区的药品可及性明显高于中部和西部地区。全国范围内 30 种药物的中位数 MPR 保持稳定，约为 5；东部地区的 MPR 明显高于中部和西部地区，创新品牌与仿制药的 MPR 比值从 2011 年至 2014 年从 3.66 增加到 6.32。基本药物引起的 CDE 的发生率从 2011 年到 2014 年下降；与仿制药相比，名牌药品更容易引起 CDE，农村患者更有可能陷入 CDE。
在实施国家基本药物政策后，基本药物的 MPR 得到了很好的控制，在可及性稳定的情况下变得更加负担得起。这凸显了基本药物供应方面地区差异和城乡不平等的问题，需要建立可持续的机制，深化中国内地的国家基本药物政策。
