Long-term Sustainability of National Essential Medicines Policy in Primary Care System in Rural Southwestern China from 2012-2017: Discrepancies by Facilities and Medicines
Author(s)
Xuechen Xiong, PhD1, Li Luo, PhD2, Jianchao Quan, MD1, Allen TC Lee, MD3, Linda CW Lam, MD3, Zhaohua Huo, PhD3.
1The University of Hong Kong, Hong Kong SAR, China, 2Fudan University, Shanghai, China, 3The Chinese University of Hong Kong, Hong Kong SAR, China.
1The University of Hong Kong, Hong Kong SAR, China, 2Fudan University, Shanghai, China, 3The Chinese University of Hong Kong, Hong Kong SAR, China.
Presentation Documents
OBJECTIVES: The National Essential Medicines Policy (NEMP) in China, implemented since 2009, has had varying impacts on different healthcare system layers. This study examines NEMP's effects on drug availability, affordability, and usage in rural primary care in Southwestern China.
METHODS: A quasi-experimental design with pre-post comparison analysed 108,111 purchase records of 650 medicines from all primary care facilities (7 township health centres and 76 village clinics) from 2012-2017. Medicine availability was measured by the number of types supplied; usage by sales amounts; and affordability by the price index of a fixed basket of 344 medicines. Interrupted time-series analyses examined trends during the 1st-stage NEMP (2012-2015) and changes after the 2nd-stage NEMP (2016-2017).
RESULTS: The number of medicines in rural primary care kept increasing during the 1st-stage NEMP (+5.1 per quarter) but encountered significant and sustained drop after the 2nd stage NEMP. The drug price index revealed long-term increases during both stages of NEMP (+0.2% per quarter), while overall medicine sales remained steady. By medicine types, availability of traditional Chinese medicines increased and surpassed western (chemical or biological) medicines. In contrast, price rises of western medicines outstrip those of TCMs. By facility levels, village clinics encountered continuous drops in both the availability and sales of western medicines, meanwhile the edging up prices. In township centres, drug prices and sales presented milder rises, especially in western medicine and after 2nd-stage NEMP.
CONCLUSIONS: Medicine availability improved in rural primary care due to TCMs. However, challenges remain, particularly in providing western medicines amid rising prices. Further policy improvements should also address the decreasing availability and rising prices of western medicines in village clinics in rural and remote areas.
METHODS: A quasi-experimental design with pre-post comparison analysed 108,111 purchase records of 650 medicines from all primary care facilities (7 township health centres and 76 village clinics) from 2012-2017. Medicine availability was measured by the number of types supplied; usage by sales amounts; and affordability by the price index of a fixed basket of 344 medicines. Interrupted time-series analyses examined trends during the 1st-stage NEMP (2012-2015) and changes after the 2nd-stage NEMP (2016-2017).
RESULTS: The number of medicines in rural primary care kept increasing during the 1st-stage NEMP (+5.1 per quarter) but encountered significant and sustained drop after the 2nd stage NEMP. The drug price index revealed long-term increases during both stages of NEMP (+0.2% per quarter), while overall medicine sales remained steady. By medicine types, availability of traditional Chinese medicines increased and surpassed western (chemical or biological) medicines. In contrast, price rises of western medicines outstrip those of TCMs. By facility levels, village clinics encountered continuous drops in both the availability and sales of western medicines, meanwhile the edging up prices. In township centres, drug prices and sales presented milder rises, especially in western medicine and after 2nd-stage NEMP.
CONCLUSIONS: Medicine availability improved in rural primary care due to TCMs. However, challenges remain, particularly in providing western medicines amid rising prices. Further policy improvements should also address the decreasing availability and rising prices of western medicines in village clinics in rural and remote areas.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
HPR98
Topic
Health Policy & Regulatory
Topic Subcategory
Health Disparities & Equity, Pricing Policy & Schemes
Disease
No Additional Disease & Conditions/Specialized Treatment Areas