Evaluation of the implementation outcomes of the Essential Medicines System in Anhui county-level public hospitals: a before-and-after study

Abstract

BackgroundIn August 2009, China formally established the National Essential Medicines System (NEMS) and implemented this system in the government-funded primary care medical and health institutions. After nearly four years of practice, the system has already been generalized to the county-level public hospitals. This study aimed to examine the impact on the operation of the hospitals through implementing the NEMS in Anhui Province and put forward some improvement measures.MethodsFor quantitative analyses, we distributed 21 questionnaires to 21 county-level public hospitals in Anhui Province, which had implemented the national public hospital reform. Twenty valid questionnaires were returned, response rate was 95.2 %. Questions covered storage, usage and supply of essential medicines, compensation mechanisms, insurance policies, hospital incomes, service amounts and fees from January to June in each of the years from 2011 to 2013. For qualitative study, we chose three from 21 hospitals based on geographical distribution and conducted focus group interviews based on a planned interview outline centered on the implementation status of the system.ResultsFollowing implementation, the types of essential medicines stocked and the proportion of total sales that were composed of essential medicines have increased but do not yet meet the required standards issued in the government document, which was not less than 95 % and 30 % of the total, respectively. The average financial subsidies had increased by 1,665,200 yuan, and significant increases appeared in provincial financial assistance. The average inpatient fees per visit decreased by 487.41 yuan. Increases in income from medicines during hospitalization led to increases in per-visit hospitalization fees. Unexpectedly, higher financial assistance revenue also led to higher average per-visit hospitalization fees.DiscussionThe guiding role of the National Essential Medicines List remains to be reinforced, and specific lists for county hospitals should be developed. Supervision was required to implement the process of guaranteeing the storage and usage of essential medicines. The compensation mechanism was far from sound, and the leverage of the health insurance policies was not obvious. Regarding the reductions in the proportion of income derived from medicines and per-visit inpatient fees, the policy had been partially successful.ConclusionsOur results showed that the implementation of the Essential Medicines System do have a beneficial role in the reduction of the drug fees and further alleviates the burden of the masses. Much effort should be made to the redesign of the compensation mechanism, mainly including the government and the medical insurance compensation, emphasizing on both the fairness and the rationality of the compensation in the future.

China's Health Reform Update

“…In the same study, average physician service charges and therapeutic service charges increased by 137 RMB and 550 RMB ($21.00 and $85.27), respectively (93). This pattern of decreasing fiscal dependence on drug revenue and increasing dependence on other services and government subsidies is also found in other provinces (75,90) and in national studies of claims data (82). These studies suggest that increases in provider-induced demand for services are an unintended consequence of reform.…”

Does providing more services increase the primary hospitals’ revenue? An assessment of national essential medicine policy based on 2,675 counties in China

“…The findings partly suggested the expected overall effects of the EMP policy, i.e., a longer exposure to the EMP policy was associated with an increased out-patient services overall, but partly a side effects of the financial issue for primary healthcare facilities, i.e., a reduced income associated with longer exposure to the policy. The positive effect of EMP on OSP was supported by some previous studies [ 7 – 9 , 39 ]. A study in Hubei province found an obvious increasing in OSP after implementing the EMP [ 7 ].…”

A Study on the Efficiency and Productivity of County-Level Hospitals from the Perspective of Regional Contrast in China: Data Envelopment Analysis and the Malmquist Index

“…As early as the 1950s, the formation of a rural tertiary health care network provided strong support for China's primary medical services [1] . County-level public hospitals, as the leaders of China's three-tiered rural health care network, have a positive effect on the normal use of tertiary health care networks [2][3][4] . As medical institutions for the treatment of frequently occurring and common diseases, county-level public hospitals have been affected by their own efficiency in addition to objective reasons such as regional economic and social development [4][5] .…”

“…County-level public hospitals, as the leaders of China's three-tiered rural health care network, have a positive effect on the normal use of tertiary health care networks [2][3][4] . As medical institutions for the treatment of frequently occurring and common diseases, county-level public hospitals have been affected by their own efficiency in addition to objective reasons such as regional economic and social development [4][5] . If a hospital's operating efficiency is low, more government investment will fail to improve its efficacy and waste resources, exacerbate the shortage of resources, and affect patients' medical experiences.…”