Translated Abstract
National Drug Policy is a series of framework, including laws and regulations, drug selection, drug supply, quality assurance, rational drug use, production and human resource development, etc, aiming to promote equitable access to quality drugs and rational drug use. By 2011, more than 100 countries have implemented a national drug policy. China has implemented the National Essential Medicine System（NEMS）since 2009 and all the government-run primary health institutes have implemented this policy by the end of 2011. Next priority is to expand the NEMS to county level medical institutions and public general hospitals. ＂Three Unified＂ policy (unified procurement, unified price and unified distribution) is an important measure of NEMS in Shaanxi Province and the governmnet began to promote the county-level public hospital reform in 2012. As one of medical service providers, hospital pharmacists’ knowledge and awareness of the NEMS has a direct impact on the implementation of this policy, so it is very necessary to investigate hospital pharmacists’ cognition of the system since 2009. The initial effect of this policy has been gradually revealed, and drug cost is a major component of medical cost, so it is particularly important to explore the medicines affordability after the implementation of the policy.
This study was designed to evaluate the research progress and implementation of NEMS from both theoretical and empirical aspects, and provide suggestion to improve this policy. Firstly, we evaluated the implementation situation of National Drug Policy in BRICS countries by systematic review, so as to provide references to promote the improvement of China＇s drug policy. Then we reviewed the research process of NEMS of China, analyzed the current research deficiencies and proposed improvements. Afterwards, we investigated hospital pharmacists’ knowledge, attitudes and practices towards NEMS and explored the influencing factors of their knowledge level by a self-made questionnaire. Finally, this study evaluated medicines affordability of Shaanxi Province in 2010 and 2014 using WHO/HAI method, impoverishment and catastrophic method, respectively.
The research results showed that: ①The main points of drug policy in BRICS countries are different, for instance, Brazil launched the NEMS and “polular pharmacy”; Russia is providing free health care for all residents, and pharmaceutical separation system is established, but patients still pay out-of-pocket for most drugs; India vigorously promoted the development of local pharmaceutical industry, so a competitive international pharmaceutical industry has been established; China has implemented NEMS since 2009, the key point of which is zero mark-up policy; South Africa implemented the NEMS to ensure that all people have the equitable access to essential medicines, and one of key points is establishing a comprehensive medicines procurement and distribution system. ②Currently, most empirical researches are about the implementation effect of NEMS, such as the supply and distribution, drug costs and rational drug use. ③The average score of hospital pharmacists’ knowledge of NEMS was 4.09 ± 1.11 and attitude part was 20.36 ± 2.96, they were both at medium level. ④Education level (p = 0.022) and the number of training (p = 0.028) were significantly associated with hospital pharmacists’ knowledge level. ⑤The most concerned problem of the majority (83.9%) of hospital pharmacists was about the supply and distribution of essential medicines. ⑥Affordability of original branded medicines were bad, especilly affordability of Losartan was the worst. A course of Losartan needed 4.1 times the minimum daily wage in 2014, leading to 37.52 thousand people into poverty and 0.653 million people into catastrophic expenditures. ⑦The overall affordability of generic medicines were good, and all the treatment costs were less than the minimum daily wage except Losartan. Of which the best was ranitidine for acute gastritis, and a course of ranitidine only needed less than 0.1 time the minimum daily wage.
Conclusions: ①Although the main points of drug policy in Brics countries are different and they all have their own characteristics, the target is the same, namely aiming at ensuring public＇s equitable access to low-cost and quality medicines. ②The evaluation of NEMS should both based on national condition and be combined with the research frontier of international drug policy field. It’s significant to conduct many in-depth studies concerning of the accessibility, quality and rational drug use. ③The government should strongly focus on the introduction of talent, regular training and make the appropriate assessment to promote hospital pharmacists’ awareness of the NEMS. ④Affordability of original branded medicines were bad while that of generic medicines were good except Losartan. ⑤Affordability of hypertension medicines were the worst and the best was ranitidine for acute gastritis. ⑥The overall medicines affordability improved in 2014 than that in 2010.
Based on the above findings and conclusions, we put forward suggestions as following: ①Establish scientific and reasonable evaluation methods on NEMS, especially on availability and affordability. ②Conduct nationwide surveys and longitudinal continuous studies on NEMS. ③Strengthen collaboration with international drug policy research field. ④Conduct the quality conformance evaluation between original brands and their generic substitutes. ⑤Improving medicine affordability by taking mutiple measures. ⑥Promote connection of Essential Medicine List with medical insurance.
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