School of Health Policy and Management, Nanjing Medical University, Nanjing, China.
School of Pharmacy, Nanjing Medical University, Nanjing, China.
Front Public Health. 2022 Apr 12;10:860471. doi: 10.3389/fpubh.2022.860471. eCollection 2022.
This study aimed to evaluate the price, availability, and affordability of essential medicines in primary healthcare institutions in Jiangsu Province.
A mixed longitudinal and cross-sectional survey was conducted in primary healthcare institutions in Jiangsu based on the adjusted World Health Organization and Health Action International methodology. 45 essential medicines were collected from 30 primary healthcare institutions in Nanjing from 2016 to 2020. We also collected information on these medicines in 70 primary healthcare institutions across seven cities of Jiangsu in 2021. The availability, price, and affordability were compared with matched sets. Differences of availability between years and cities were further compared using Wilcoxon rank-sum test.
In Nanjing, the variation was significant of availability during the study period. The MPR was generally decreasing between 2016 and 2020, with the median price ratio (MPR) for lowest-priced generics (LPGs) ranging from 1.20 to 2.53 and originator brands (OBs) substantially above international levels. The median availability of generic medicines increased in 2018 and subsequently stabilized at around 55%, and the availability of originator medicines was low. There were no significant regional differences in prices across the sampled cities in Jiangsu, and the median MPR for LPGs was acceptable (1.23), while the median MPR for OBs was 8.54. The mean availability was different across regions ( < 0.001), being higher in Nanjing (54.67%) and Nantong (56.22%), and lower in northern Jiangsu (about 35%). For LPGs, there was little difference in the proportion of medicines with low availability and high affordability (50.00% for urban residents and 40.48% for rural residents). For OBs, there were more than half of rural residents had low availability and low affordability of medicines (58.82%).
In terms of yearly changes, the prices of essential medicines have considerably decreased, and the availability of LPGs has slightly increased. However, the availability of medicines was found to be poor and there were regional differences in the availability and affordability of medicines among metropolitan and rural areas. Policy interventions targeting external factors associated with health resource allocation are essential and possible strategies include effective and efficient government investment mechanisms on primary healthcare.
本研究旨在评估江苏省基层医疗机构基本药物的价格、可及性和可负担性。
采用世界卫生组织和健康行动国际组织调整后的方法，对江苏省基层医疗机构进行混合纵向和横断面调查。2016 年至 2020 年，从南京市 30 家基层医疗机构采集 45 种基本药物。我们还收集了 2021 年江苏省 7 个城市 70 家基层医疗机构的这些药物信息。将可及性、价格和可负担性与匹配集进行比较。使用 Wilcoxon 秩和检验比较各年份和城市间的可及性差异。
在南京，研究期间的可及性变化显著。2016 年至 2020 年，MPR 总体呈下降趋势，最低价格仿制药（LPG）的中位数价格比（MPR）范围为 1.20 至 2.53，原研药品牌（OB）明显高于国际水平。2018 年，仿制药的总体可及性增加，随后稳定在 55%左右，原研药的可及性较低。江苏省抽样城市之间的价格没有显著的区域差异，LPG 的中位数 MPR 是可以接受的（1.23），而 OB 的中位数 MPR 为 8.54。各区域的平均可及性存在差异（<0.001），南京（54.67%）和南通（56.22%）较高，苏北较低（约 35%）。对于 LPG，低可及性和高可负担性的药品比例差异不大（城镇居民 50.00%，农村居民 40.48%）。对于 OB，超过一半的农村居民的药品可及性和可负担性都较低（58.82%）。
从年度变化来看，基本药物的价格大幅下降，LPG 的可及性略有增加。然而，药物的可及性较差，城乡地区药物的可及性和可负担性存在区域差异。针对与卫生资源分配相关的外部因素的政策干预是必要的，可能的策略包括对初级保健的有效和高效政府投资机制。
