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ORIGINAL RESEARCH article

Front. Public Health
Sec. Public Health Policy
Volume 12 - 2024 | doi: 10.3389/fpubh.2024.1355239

Short-and Long-term Impacts of the National Essential Medicines Policy on Drug Availability, Price, and Usage in a Deprived Rural County in Southwestern China: An Interrupted Time Series Analysis Across Eight Years

Provisionally accepted
Xuechen Xiong Xuechen Xiong 1Zhaohua Huo Zhaohua Huo 2Shuai Zhou Shuai Zhou 3Ge Bai Ge Bai 4Shiying He Shiying He 5Yinan Zhou Yinan Zhou 6Jing JIA Jing JIA 7Jianchao Quan Jianchao Quan 1Li Luo Li Luo 4*
  • 1 The University of Hong Kong, Hong Kong, Hong Kong, SAR China
  • 2 The Chinese University of Hong Kong, Hong Kong, Hong Kong, SAR China
  • 3 Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
  • 4 Fudan University, Shanghai, Shanghai Municipality, China
  • 5 School of Public Health, Fudan University, Shanghai, Shanghai Municipality, China
  • 6 Fudan University, Shanghai, China
  • 7 Chinese university of Hong Kong, Hong Kong, Hong Kong, SAR China

The final, formatted version of the article will be published soon.

    Background: China’s National Essential Medicines Policy (NEMP) has been implemented for over 15 years; yet empirical evidence on its long-term impacts is lacking in remote and rural regions. This study aims to assess the short- and long-term effects of NEMP on the drug availability, price, and usage in a deprived rural county in southwestern China. Methods: A quasi-experimental design was employed, featuring a single-group pre-and-post comparison. We gathered 74,436 procurement records from 2009 to 2016 from drug warehouses of local medical institutions. Pharmaceutical data were analysed quarterly, considering various policy and therapeutic attributes. Drug Price Index was calibrated for retail and wholesale prices of 405 medications. We conducted interrupted time-series analysis to examine the immediate and enduring impacts of NEMP’s initial (commencing in January 2011) and second (starting from December 2015) stages. Results: After NEMP, the number of essential medicines surged by 115 but subsequently faced a steady quarterly decline (-9.1) in township healthcare centres (THCs, primary care). Conversely, county hospitals (secondary care) initially saw a reduction of 40 medicines but later exhibited a steady increase (+4.2 per quarter) up to the second-stage NEMP. Regarding price, THCs encountered abrupt (-26.1%/-15.9% in retail/wholesale price) and sustained (-0.2%/-0.3% per quarter) price drops after NEMP. The immediate price change after NEMP in county hospitals were milder but significant in non-essential medicines, and long-term declines were also observed in all drugs. As for total sales, a significant long-term disparity emerged between THCs (+0.9% per quarter) and county hospitals (+3.3% per quarter). Following the second-stage NEMP, retail prices in county hospitals further decreased, although wholesale prices did not; however, following price upward trends were observed in both THCs and county hospitals. Lastly, the influences of NEMP varied across different therapeutical categories of medicines. Conclusions: NEMP has successfully regulated drug prices in primary and secondary healthcare facilities in remote and rural areas, both short-term and long-term. However, a remarkable disparity in medicine availability and utilization was observed between different levels of facilities over time. Continuous monitoring is essential, with increased attention needed on the uneven impacts of the policy on diverse drugs, facilities, regions, and demographics.

    Keywords: Essential medicine, Drug price, Centralized procurement, rural, Primary Care

    Received: 13 Dec 2023; Accepted: 15 Aug 2024.

    Copyright: © 2024 Xiong, Huo, Zhou, Bai, He, Zhou, JIA, Quan and Luo. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Li Luo, Fudan University, Shanghai, 200433, Shanghai Municipality, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.