The Essential Drug System Helped on Burden Alleviation but Still Need Improvement


[August 13, 2011, Hangzhou] A survey on 30 city- and county-level grass-roots medical institutions shows, after implementation of essential drug system, the average fee for out-patients and emergency treatment in various areas has been obviously declined, with average magnitude by 25-30%. The result indicates that the implementation of essential drug system has achieved a good effect in burden alleviation in the above areas. However, during the survey, in the enforcement regulation of essential drug system in the above areas, there remains a space for further optimization in regional difference and promotion of grass-roots medical institutions. 

The development of grass-roots medical institutions needs to be paid with attention  

The study has carried out a statistical analysis on the statement of the essential drug system between March and December, 2010 inthe first batch of 30 cities and counties implementing essential drug system in East China. The statistics indicates that after implementation of the essential drug system, the person-times of out-patients and emergency treatment grew obviously year on year between March and April, but dropped progressively. As of August, the increase was only 2.3% and individual developed areas occur with drop even by 22.6%. As forZhejiangProvince, the person-times of out-patients and emergency treatment for general hospitals were 156 million in 2010, up by 11.4% over 140 million person-times of out-patients and emergency treatment in 2009. In 2010, the person-times of out-patients and emergency treatment for township health centers and community health service centers (stations) were 123 million, an increase by 6.0% over 116 million in 2009. The growth of out-patients and emergency treatment for general hospitals was higher than grass-roots medical and health institutions. It is clear that, the implementation of essential drug system makes it possible for more patients to access two or three-level medical institutions from grass-roots medical and health institutions. The loss of patients is relatively serious especially in urban areas with adequate resources of two or three-level medical institutions.  The possible reason is that most patients have more trust on large hospitals. If a community doctors request patients to replace the drugs on prescriptions from doctors of large hospitals, it may be difficult to accept for many patients. The loss of grass-roots medical and health institutions may result in benefit damage and brain drain over a long period, which is not conducive to the implementation of policy on treatment of minor diseases in community hospitals and two-way referral. In the meantime, the research also indicates that the flow of patients witnesses a trend of growth in pace with the increase of drug allocation for grass-roots hospitals. 

The stones from other hills may serve to polish jades  


In the process of economic development, Taiwan has a lot of things in common with East China, therefore, the experience of Taiwan in managing grass-roots medical institutions and medical insurance has a good reference function for us to further optimize the existing system. "No design of essential drug system is available in Taiwan. The scope of payment for medical insurance drugs almost covers TFDA (Taiwan Food and Drug Administration), which accounts for more than 95% of verified ethical. Besides, seeking medical advises from grass-roots clinics, the part borne by individuals is far lower than seeking medical advices in high-level medical institutions. Compared with large hospitals, grass-roots clinics have a distinct division in diagnosis and treatment range, but they adopt the same health insurance drug use catalog in aspect of drug, plus smooth two-way referral mechanism, medical institutions of two different types have realized seamless connection in clinical use of drugs and ensure the service of large hospitals to be effectively extended to community medical institutions, which is especially important for management of chronic diseases." Prof. Huang Wenhong with the Health and Welfare Institute of Yangming University said, "grass-roots clinics in Taiwan are mostly run by private persons, and the competition is highly market-oriented. If the qualification of doctors is not recognized, the clinics will be difficult to survive, and many doctors of existing clinics have worked or received the training in medical centers and other large medical institutions. In outlying districts, the government will offer preferential policies and fund support to encourage doctors to go there for practice. So, the health insurance drug use catalog similar to large hospitals, favorable payment policy plus faithworthy doctors have made grass-roots clinics in Taiwan win the trust of quite a few people, with the satisfactory development state and playing an indispensable role in medical system in Taiwan. ”
 At the same time, Prof. Huang held that the essential drug system is aimed at providing the most essential drugs required for medical service, which adapts to the demand in countries and regions which are underdeveloped in economy and scarce in medical resources. Most countries adopting essential drug system have no independent pharmaceutical industry. As China has a vast territory and varies greatly in economic development, the existence of essential drug system is absolutely necessary for comparatively underdeveloped districts, but for developed regions, the publics requirement for grass-roots medical institutions may exceed the range served by essential drugs. The unified essential drug system is bound to face many challenges during the implementation. Besides, purchase of essential drugs in a way of centralized bidding will certainly reduce the drug expenditures, but it may influence the stable development of pharmaceutical industry and have an adverse effect upon the drug quality. In this regard, the confidence of the public to the drug quality is of the utmost importance.

Adaption to local conditions may provide a greater vitality for essential drug system  


East China is one of the most developed areas in China, however, the difference in economic development degree and medical resource distribution at different districts and counties within one province is even more than the integral difference between eastern and western regions. Thus, even within a province, there also is adaptive issue with unified essential drug catalog. Within 30 counties and cities investigated by the research institute, one-third drugs among 307 national essential drug categories are seldom used. The drugs have not been adequately distributed in quite a few counties and cities, among others, the least drugs are only 172 kinds. During the implementation of essential drug system, if it is possible to give comprehensive consideration to the local economy and medical level according to local conditions and offer more flexibility to the local medical institutions, especially those on district and county level. It will certainly ensure the system to serve the common people in a better way and also pursue the development of grass-roots medical institutions.

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