Exploration and Experience of Establishing Essential Medicines System
Hu Shanlian. MD. MSc. Professor. School of Public Health, Fudan University
The promulgation of “The Implement opinion on establishing national essential medicine system” and a series of policy document issued on August, 2009, showed the launch of China essential medicine system. The target of national essential medicine policy is to establish a comprehensive and universal coverage of NMP by the year of 2020 in China.
The establishment of essential medicine system is a systematic engineering, which contains a cycle of selection, production, distribution, utilization, pricing, reimbursement, monitoring and evaluation. The main contents include: the selection of essential medicines, formulation of essential medicine list and its dynamic management; issuance of the production and insistence the priority of quality and reasonable pricing; establishing government-oriented and province-run pooled procurement, unified distribution and zero mark-up on the sale; pricing setting by the government to ensure the access of essential medicine in the lower income population. For those drugs that their price are set by the government reference price should be strengthening on cost auditing, on the other hand, if the price of some drugs is set freely by the manufacturers that will be monitored on the market and supervision on the real mark-up price during the process of distribution. For those non-essential medicines that will be conducted differential price, the price should be compared between strengths and dosage. Commercial bribe should be avoided. The management capacity of modern logistic distribution system of pharmaceuticals should be strengthening. All EM should be list in the various medical insurance reimbursement schemes. The reimbursement ratio of essential medicines must be higher than that of non-essential medicines (5%-10%). The monitoring and evaluation of essential medicine system should be made through information system.
After one-year implementing essential medicine system, a great achievement has been made in China. More than 35.7% of cities and counties has been implemented NMP. The average price of essential medicines has been declined about 25%-50% of original price before the bulk purchasing. The number of outpatient and inpatient is significantly increased. The patient flow tends to be reasonable. The average cost per ambulatory visit and admission to the hospital is declined accordingly.
Much best practice has been created on the exploration of compensation model of essential medicine policy, such as by using the combination of budgeting and accounting method to make the financial reimbursement. Using government subsidies supports the construction of village posts and the income of village doctors, or even establishing prescription fee compensated by medical insurance for community health centers. After eliminating the drug markup, local government and medical insurance fund should be reimbursed respectively. Other secondary and tertiary hospitals should also be used essential medicines as the first choice and identified a certain amount of proportion. Doctors are based on pay-for- performance in the utilization of essential medicines.
However, the implementation of essential medicine policy is also facing many problems. Since the items of essential medicine used in urban community and rural township health center only allow 307 items, the number is not enough to meet the need of patients. After implementing zero mark-up policy on drug sale, the drug revenue in grass-root health facilities is declined significantly. The financial support is not subsidized timely. Many patient have to purchase non-essential medicine back to the hospitals, it exacerbates the contradiction between doctor and patient. Lack of effective measurements on strengthening the training of medical professional on using essential medicines and changing the behaviour of rational use of drug in patients. The distortion of price between bulk procurement price and market price showed that the market competition force has not been fully used in the procurement and distribution process. Government needs to supervise more on the quality, procurement and utilization of essential medicines.
Finally, NMP is a key point and an innovative system in China. To some extent, it is one of the systems more difficulties for operation. Because it is an interest related to multiple sectors and stakeholders, including pharmaceutical enterprises, government finance, price and health sectors, medical professionals and patients. In sum, the foundation and condition of the sustainable development of essential medicine system is need to create and improve continuously.