Overprescribing In China, Driven By Financial Incentives, Results In Very High Use Of Antibiotics, Injections, And Corticosteroids

Abstract

In appropriate prescribing is a global problem. It is especially salient in China, where drug sales constitute a major portion of health care providers' incomes, price distortions are rampant, and oversight is lax. However, few data exist on the prevalence of inappropriate prescribing in China. This study, the first of its kind in China, examined 230,800 prescriptions written between 2007 and 2009 by 784 community health institutions in 28 cities across China. The data show substantial overprescribing, including twice as many prescriptions for antibiotics as recommended by the World Health Organization and rates of injection that are three times higher than in similar countries. These findings point to the need to integrate rational prescribing into China's ongoing health care reform. M arket-oriented reforms in the past three decades have brought unprecedented economic prosperity to China. At the same time, they dismantled the structure of China's equitable, albeit rudimentary, health care system. Today, with the Chinese Ministry of Health setting very low prices for physician consultation, hospitalization, and services, drug "markups" have become the major source of revenue for health care providers.Unlike the United States and many other countries, China does not have a widespread retail pharmacy system. Patients typically fill their prescriptions at the same hospital or clinic that they visit for care. These health care providers don't receive a dispensing fee but rather earn the difference between wholesale and retail price. Because these drug-related revenues are a major source of financial support for health care providers, one of the detrimental consequences is inappropriate or irrational prescribing. 1The irrational prescribing is further exacerbated by runaway manufacturer prices and lax oversight. This environment poses a serious risk for patients' health and sources of health care. 2Recognizing the ever-worsening problems in basic health care coverage, disease-induced poverty, disparities, and the resulting social instability, the Chinese government has launched a multitude of reforms. Central to the reforms has been the reconstruction of affordable and convenient community health service networks that provide basic disease prevention, medical treatment, rehabilitation, health education, and family planning services within designated urban communities. These networks are composed of health centers, each providing about 50 beds and serving 30,000 to 50,000 residents, and satellite health stations, each serving about 3,000 residents. 4 Most of these institutions are owned or subsidized by municipal governments; the rest are owned by private practitioners, trade organizations, and other nonprofit entities.5 By the end of 2008, 98 percent of the cities in all of China's thirty-one provinces had developed community health service networks. 6 In 2010 China's minister of health, Zhu Chen, Reform In China

Antibiotic misuse among university students in developed and less developed regions of China: a cross-sectional survey

“…In China, antibiotics misuse is pervasive [6,7], leading to very high and growing rates of AMR in both hospital and community-acquired infections [8–10]. A review of antibiotic use in China demonstrated that 80% of inpatients and 50.3% of outpatients were prescribed with antibiotics, and as many as 75% of patients with seasonal influenza were treated with antibiotics [11].…”

Exploring the evidence base for national and regional policy interventions to combat resistance

“…12 In China, antibiotics are substantially overprescribed as drug sales revenue constitutes a major proportion of healthcare providers' incomes. 63 In response to increasing AMR, China's first explicit attempt to rationalize antibiotic use came in the shape of national hospital guidelines (2004) 64 and a concurrently launched containment policy, which sought to ban the sale of antibiotics to patients without prescription. 65 The effectiveness of these policy measures was not systematically evaluated, and weak enforcement is likely to have limited their impact.…”

“…63 In 2007, an estimated 90,000 tons of antibiotics were used in humans. 73 The Ministry of Health (MoH) set up the National Healthcare Associated Infection Surveillance System (NHAISS) in 2001 to monitor antibiotic usage in hospitals, 74 and the MoH National Antibacterial Resistance Investigation Net (Mohnarin) in 2004 to detect and monitor antibiotic resistance.…”

Initiatives to increase the prescribing of low cost generics; the case of Scotland in the international context

“…generic statins accounted for only 9% to 10 % of total statins in recent years in hospitals in China international context (175). The low use of generics is exacerbated by the need for hospitals to make money from drug procurement for their sustainability and physicians to supplement their income, with this incentive system also stimulating overuse of injections (174,(176)(177)(178) Box 2 -Potential requirements to successfully implement a generic substitution policy (adapted from (118)).…”