An analysis of China's national essential medicines policy

Abstract

Although China embraced the concept of essential medicines in 1979 and issued its first National Essential Medicines List in 1982, until recently China has lacked a comprehensive national essential drug policy. In its most recent health-care reform (2009-2012), the Chinese government explicitly proposed the establishment of a national essential medicines system, and made it one of five top priorities in the coming years. We review the evolution of China's essential medicines policies, explain the importance of fully implementing the essential medicines policy, and analyze recent policy developments surrounding essential medicines.

China's Health Reform Update

“…In terms of covered services, the Urban Employee Insurance program is most comprehensive for both inpatient and outpatient care, whereas both Urban and Rural Resident Insurance cover primarily inpatient care and some outpatient services for selected chronic conditions. Since 2009, a national reimbursement drug list set 2,349 medicines under regulated price controls (23). Following the most recent policy development, the national reimbursement drug list will be updated by the end of 2016.…”

“…In particular, the Essential Drug List (EDL) was created, including 307 western and traditional Chinese medicines (23). A subset of the National Reimbursement Drug List maintained by the national medical insurance program, the EDL identified drugs of particular importance to primary care services across the country.…”

“…Upper-tier facilities are encouraged, but not required, to follow the policy (46). Provinces are allowed to independently create supplemental lists, providing the system with flexibility to adapt policy to local needs (23,65). Hospitals are no longer allowed to buy medications directly but instead have to purchase medications through a bidding process managed by the provincial government.…”

Evaluation, in three provinces, of the introduction and impact of China’s National Essential Medicines Scheme

“…However, the official documents for this reform provide only guiding principles that encourage the local adaptation and piloting of the NEMS, 21,22 including the use of the National Essential Drugs List (now widely augmented 14,23 ) and strategies to compensate health-care providers for income lost as a result of the zeromark-up policy.…”

“…3,10 The fact that hospitals and doctors derive substantial profits from drug sales 4,11 makes health care unaffordable for many. 12,13 Poor regulation of drugs also raises safety concerns 4,14 Previous efforts to improve the pharmaceutical sector in China have not been very successful. The impact of laws, decrees and 24 separate price reductions introduced between 1996 and 2007 was lessened by systemic issues (e.g.…”