Study On Strategies Of Improving Access To Essential Medicines In Rural Of China

ObjectIt has policy importance and theory value to improve access to essential medicines inrural of China. In order to evaluate the status of access to essential medicines, analyze thekey problems, and provide reference for policy adjustment based on NCMS, a survey basedon the method recommend by World Health Organization and Health Action InternationalEurope was conducted in rural areas of Hubei province. After summarizing relative theoriesand influencing factors of access to essential medicines, strategies on promoting access toessential medicines were proposed, which are meaningful to the setting of nationalessential medicines policy.Data and MethodsBoth quantitative and qualitative methods were used. Literature review, fieldinvestigation and statistical methods were used in this study. The data included: literaturedata on access to essential medicines; data on availability and price in hospitals and retailpharmacies of counties and towns surveyed, including procurement price and retail price ofessential medicines and prescriptions in hospitals, while retail price in retail pharmacies. 18hospitals and 18 retail pharmacies belonging to Wuhan, Xiaogan and Enshi were surveyed. Results1,The status of access to essential medicines in Hubei province(1)The difference of geographical accessibility in rural of China was large. West ofChina was easy to lack of essential medicines caused by geographical factors. But it wasimproved by increasing the proportion of village health facilities.(2)Low availability of essential medicines, ever innovator brand or generics surveyed,was found in both sectors, and more in the hospitals. The most of essential medicines foundwas generics.9 innovator brand were found in the hospitals and 6 in retail pharmacies.Generics of low availability was 43.6%, while generics of high availability was 12.8%.(3) The median MPRs of procurement prices for LPGs (60% of the MSH referenceprice) had indicated efficient procurement. For retail prices in hospitals, the median MPRsof generics was 0.9 times the international reference prices. Even though the hospitalsreceived a good procurement prices, the markups between procurement and retail priceswere high (median markups rate of innovator brands and generics: 20.5% and 32.5%,respectively). Therefore, the hospitals still attained a lot of profits from selling medicinesand the benefits of low procurement prices were not transferred to the patients.The median MPRs of generics of retail prices in retail pharmacies was 0.5 times theinternational reference prices. Retail prices in hospitals were higher than in retailpharmacies except Metronidazole. The largest retail prices ratio between the two sectorswas 4.66. The retail price in hospitals was1.57 times of that in retail pharmacies.(4) The affordability was chiefly determined by the availability and price. Theaffordability of 16 medicines to 7 diseases was calculated. For the social average incomepopulation, the affordability of 12 medicines was much optimistic. But for the low-incomepopulation, even the expenditure of essential medicines for treatments was unaffordable,namely the common diseases would cause poverty.(5) The percentage usage of essential medicines was not high, and irrational use ofmedicines was existed. The percentage usage of essential medicines belonged to WHOEssential Medicine List (2007), National Essential Medicine List (2004, China) and NewRural Cooperative Medical System Essential Medicine List (Second Edition) were 44.3%,77.5%and 71.8%. The average number of drugs per prescription was 2.5, higher than 2. 2,The roots causing low access to essential medicines in rural were(1)lack of systemic planning in entirety at country level;(2)missing or retreat of government function;(3)low economic and culture development in rural.Conclusions1,Though geographical accessibility in rural was improved, availability of essentialmedicines was low.2,The procurement prices in hospitals was far away lower than the international referenceprices. Since the markups between procurement and retail prices were high the benefits oflow procurement prices were not transferred to the patients.3,Retail prices in hospitals were higher than in retail pharmacies, and the difference ofsome medicines between the two sectors was large.4,The affordability was much optimistic for the social average income population ,whileunaffordable for the low-income population.5,The percentage usage of essential medicines was not high, and irrational use ofmedicines was existed.6,It needs to take synthetical measures to improve access to essential medicines.SuggestionsWe suggested that essential medicines policy should be estabilished, essential medicines listshould be selected strictly, running mechanism of stable financial policy should be set up,supervision and evaluating system should be strengthened, and improving advertising andeducation on essential medicines.