research on the implementation of the essential drug system in china rural health facilities
DESCRIPTION
Wang YunPing of the China National Health Development Research Center gives a presentation on behalf of her boss, Director Zhang Zhenzhong about reforming China's essential drug system.TRANSCRIPT
Research on The Implementation of Essential Drug System in China
Rural Health Facilities
Zhang Zhenzhong, Wang Yunping
China National Health Development Research Center
Outlines
Background
Progress of EDS Implementation
Some preliminary findings and discussions
Summary
Background
Why the drug price is so high?
The more agents and distributors involved, the more mark-up taches, and thus the higher prices of drugs and heavier economic burden on patients.
Before the reform, the mark-up taches in China
50% 30%-50% 12%-15% 7%-15%
Manufacturer Sale agent Distribution enterprise Hospital Patients 。。。 。。。
Background
Surviving rational for rural grass-root health facilities:
compensate the cost of medical health services
through the profit via selling drugs
In 2009 for public township health centers:
• Revenue from selling drug income in its total business income:
55.03% (western areas ≥70%)
• Fiscal input in its total income: 18.98%
Background
Launch of National EDS: 2009
Objectives of National EDS: ensure the utilization of ED, alleviate the
economic burden of drugs for the population
Main tasks and features:1. NED list: 307, allow expansion in province, update every 3 years
2. Regulate the production and distribution, and tender for bidding at provincial level
3. Set national retail sales guiding price for ED
4. Equip and use EDs in public grass-root health facilities, and 0 mark-up for EDs
5. Facilitate the priority selection and rational use of EDs
6. Provide higher reimbursement rate for EDs in medical insurance schemes
7. Strengthen the supervision on EDs safety and quality
8. Improve the performance evaluation system on EDs
Progress of EDS Implementation
From 2010 – Apr. 2011: has covered 86% public grass-root health facilities
Data source: WHO Beijing office, Tongji Medical University , CNHDRC, Evaluation on Essential Drug System implementation Progress.
Financing the grass-root health facilities for the gaps after implementing the EDS
Financing Methods
“Replacing compensation by rewards” policy: combine the volume and
quality of the basic + major public health services accomplished, as
well as the performance of general reform on personal management,
performance related payment, patient satisfaction and etc. with the
fiscal subsidies
Differential fiscal subsidies-direct subsidies: compensate the gap
based on the average total business income and cost in the previous 3
years
Bill on medical insurance: medical insurance V.S. fiscal input is 7:3 or
6:4 for the 15% mark-up gap
Change of the price after EDS reform
Nationwide average price of EDs:
decline 30% + , due to 0 mark-up policy.
Hebei
Hunan
Zhejiang
Liaoning
Anhui
Sichuan
-46
-47
-45
-34
-50
-54
Change of EDs price in selected areas
compared with national guiding price
But some EDs in some areas:
Price after bidding is much higher
Is this proposition true? Even though in most areas, the EDs price is declining, if
Declining EDs price = Declining economic burden of health exp.?
唯低价是取的招标采购
• 基药供给不足• 质量降低
药物收入缺口补助不到位
• 医务人员工作积极性降低
• 上转患者• 多检查• 门诊转住院• 替代药
患者用药习惯•流向大医院•社会药店购药
Reduce the EDs price
Declining EDs price, but might be increasing economic burden of health exp.
Some preliminary findings
Although it is too early to make any conclusion,
however, some phenomenon should be paid
attentions to…
Change of the volume of health services utilization at rural grass-root health facilities
1st quar. 2011
( 10,000 pt)
1st quar. 2010
( 10,000 pt)
Change volume
( 10,000 pt)
Rate(%)
THC outpatient 20240.1 21624.3 -1384.2 -6.40
inpatient 768.2 889.4 -121.2 -13.63
Beds utilization Rate 57.4 59.8 -2.4 -4.01
Secondary
hospital
outpatient 22123.5 20489.6 1633.9 7.97
inpatient 1267.5 1153.3 114.2 9.90
Beds utilization Rate 90.2 87 3.2 3.68
Table 1 Change of the volume of health services utilization from 2010-2011
Data source: Health Statistics Year Book 2010, MOH, China
Change of the distribution of NCMS reimbursement fund at rural grass-root health facilities
In 2010: reimbursement for inpatients in upper hospitals outside the county and county hospitals has increased 16.69%、 14.8%; in THC has declined 2.59% than 2009.
Areas
Upper hospitals out-side county County hospital THC
2009 2010 2009 2010 2009 2010
East 35.64 36.95 43.81 43.24 20.55 19.81
Middle 35.23 38.78 38.58 39.49 26.19 21.73
West 31.93 34.18 37.49 39.37 30.58 26.44
nationwide 34.44 36.89 40.07 40.67 25.49 22.44
Table 2 Distribution of NCMS reimbursement fund for inpatients
Data source: Research Center on NCMS of MOH, China
Why these Unexpected Outcomes Happen?Political economical
social cultural
EffectiveEDs
delivery
suppliersupplier ConsumerConsumer
Gov. Gov.
Pharm. enterprisePharm. enterprise Drug
storeDrug store
Drug retailerDrug retailer
Others …Others …
Upper hospitals
Upper hospitals
Adaptive agents
Further tracking & analysis
Opportunities in the predicament for the rural grass-root health facilities
Hold back the arms race on medical equipment and
constructions
Reallocate and integrate the health resources in rural areas
Transition of the functions of rural health facilities: balance the
public health service and medical services
Unprecedented policy attentions and fiscal input to village
doctors Facilitate the comprehensive reform on rural grass-root health
facilities, especially the performance management and quality management.
Summary
When introducing a new system will break down the original
interest pattern, collide with and pose pressure to the old
environment.
To stimulate the agent and environment in the old system
more quickly and effectively, the research from complex
adaptive system perspective is needed, to analyze the
adaptive capacities and behaviors of the agents and the
interactions between new and old system components.
A Chinese old saying : “Break to Found, fail to succeed”.
Thank you for listening!