Evaluation On The Implementation Of Zero-profit Essential Medicines In Health Care Institutions Of L Province

OBJECTIVE:National Essential Drug System is designed to provide safe accessible and affordable essential drugs for residents, to control the growth of drug costs, to reduce the burden on the people and to ensure equitable access to essential medicines.This study aims to know the current situation of the national essential drug system of primary health care institutions to its income expenditure, business income and the impact of essential drugs and rational drug use between 2009 and 2013.Evaluate the implementation of Essential Medicines System in L Primary Health Care Institutions. And then propose the appropriate recommendations to promote the perfect implementation.METHODS: The L Primary Health Care Institutions can be divided into urban community health service centers and rural community hospitals according to city and countryside property.It also can be divided into southern、western and northern part.The study analysis was used to understand the history of the foreign and China’s essential medicines system, to comprehend the situation of implementation of the essential medicines system in primary health care institutions; to analysis the income expenditure and different indicators changes between 2009 and 2013 in primary health care institutions,to know the trend of development,government compensation and the use of essential drugs, including several varieties of essential drugs, the situation about concession to profits. With prescription indicators data, comparing the changes during implementation of the system before and after to analyze the basic drug use.RESULTS: Since the essential medicines system begins to carry out, the total incomeand expenditure of the medical institutions, shows an increasing trends between 2009 and 2013; the total income and expenditure of the medical institutions in each category have the same growth trends. Overall, drug revenues accounted for the proportion of revenue declined slightly, down from 67.4% in 2009 to 50.8% in 2013, closing to the national average. Primary health care sector use the national essential drugs is generally around 160-300 species, the use of the province is about 80-140 species additions.Rational drug use in primary health care institutions, the use of the decreasing number of prescriptions, indiscriminate use, the abuse of prescription drugs has been significantly improved. Compared with the 2009, the average of 100 prescriptions per intravenous prescriptions, the above average use of antibiotics Duplex number of prescriptions, and the average number of prescription steroids in 2013 has decreased significantly. That illustrate since the implementation of the basic medicine system, the utilization of essential drugs has improved and prescription indicators has normalized.The amount of compensation in rural areas higher than urban areas, the proportion of financial compensation of northern part of L province accounted increases by years, followed by southern part of L province, the compensation of western part of L province is the lowest.And outpatient revenue accounted for the proportion of revenue was 60%, higher than the national average,which the situation has improved. The amount of financial grants for grassroots medical institutions increases by years, but there are still problems of insufficient government compensation. At the same time,changes in outpatient primary health care sector is also on the rise, the fixed growth rate of outpatient revenue is 33.77%. Urban per capita outpatient costs an average of about80 yuan,about 1.33 times that in rural areas.It is below the national average and the rural`s are almost close to the national average. National essential drugs and provincial medicines income supplement drug revenues accounted constituent ratio increased year by year. The province’s 2013 inadequate compensation ratio is about 11.1%.CONCLUSION: The effect of primary health care institutions implementing essential drugs system is conspicuous and it initially appears to return to public welfare.Rational use of drugs achieve good effect. The province’s primary health care sectorshowed a total revenue increasing in recent years. However, the surplus is reducing, and even showed a loss, hospital management was affected. Compensation ratio of government finances are still insufficient. Varieties of existing essential drug list is still difficult to meet the needs of the grassroots medical institutions, the availability and accessibility of essential medicines to be further improved. Proposed to define government investment policy; build appropriate essential medicines zero sales slip compensation mode and stable financial compensation mechanisms; add Essential Drug List scientifically to realize dynamic-adjustment management.