The Research Of Essential Medicine Policy Implementation Effectat Zhabei District In Shanghai

In “the opinions of deepening the reform of medical and health system by the centralcommittee of the communist party of China and the state council”(2009) and “the keyimplementation plan issued of the medical health system reform by the state council”(2009-2011), the essential medicines system is regareded as an important part of the newmedical reform, which marked the country officially launch system for essential medicines.Before this, zero rate of essential medicines has carried in Shanghai. Shanghai issued“the trial opinions about zero rate of essential medicines implementating in communityhealth service center of Shanghai in December,2008”,and used166kinds of essentialmedicines by zero rate in community health service centers in February,2009. In December,2010, Shanghai issued “scheme for implementing national system for essential medicines(trial) in Shanghai”, which made a supplement directory, increasing381kinds of essentialmedicines. In February,2011,all of community health service center implementated essentialmedicines system.688kinds of essential medicines was sold by zero rate. From February toMay was the transition period, the drug out of directory could still be sold in communityhealth service center. From June1,2011, the community health service centers can only buyand sell directory drugs. And the community health service centers were giving the autonomyto select20kinds of drugs outside directory by themselves.From August20,2011, allessential medicines were all formal bidding price. As a huge influence health policy, what is the effect of the essential medicines systemimplementated in Shanghai, including the implementation situation, the impact on the medicalservice supply and demand situation? The existing research is less. Therefore, this researchattempts to select the Shanghai zhabei district as a typical case. Through a comprehensivesurvey of essential medicines use situation and the effect in different levels of hospital, findout the problems and put forward policy suggestions to perfect the system for essentialmedicines.The main content of this research is as follows:First, through literature analysis, study the policy evaluation theory, the essentialmedicines system, stakeholder theory, Donabedian theory and evaluation index system of theessential medicines system, etc,and formed the evaluation elements of essential medicinessystem implementation effect by experts, on the basis of the discussion.Secondly, analysing the essential medicines system implementation effect respectivelyfrom the perspective of internal and external supplier and the buyer. Through research foundthat the production,purchase and distribution process are more standardized,but the quality ofsome drug is decrease; In all levels of hospital, the equipped proportion of essential medicinesis increasing,and the varieties tends to be stable gradually,but some children’s medicine,gynecology medicine, ophthalmology medicine, cerebral infarction medicine, othercommunity commonly used medicines are not included in the list of essentialmedicines.Essential medicines usage soared.Antibiotic use is significantly lower before theimplementation of system. Government financial subsidies is insufficient,leading to thatalthough residents drug spending fell, but physician fee is not significantly fell, etc.Again, in view of the problems, suggest reasonable adjusting list of essential medicines,improving the mechanism of the drug bidding price, increasing the intensity of drug qualitysupervision, regulating distribution enterprise qualification standards, increasing thegovernment compensation, ensuring residents’ medical burden fell truly. At the same time set up incentive policy of priority use essential medicines in district hospital and tertiaryhospital,and promote residents to enhance the concept of rational drug use.Evaluation objects in this research covers all-level hospitals in Zhabei district,pharmaceutical producing and distribution enterprises, residents and retailpharmacies.Evaluation content through essential medicines production, procurement, sales,distribution, reasonable use.