Date Published: March 14, 2019
Publisher: Public Library of Science
Author(s): Wenhui Mao, Yunyu Huang, Wen Chen, Italo Francesco Angelillo.
The National Essential Medicine Policy and the Zero Mark-up Policy was introduced to improve the rational use and affordability of medicine. This study analyzed the changes of medicine use at different Health Care Institutions in Hangzhou city after the implementation of National Essential Medicine Policy and the Zero Mark-up Policy.
Facility based survey was conducted in 17 Health Care Institutions and 16406 outpatient prescriptions in 2011 and 2013 were collected. Average number of medicines, average number of antibiotics and average expenditure per prescription were analyzed. Comparisons between 2011 and 2013, among different levels of Health Care Institutions and age groups were conducted.
The average number of medicines per prescription, use of antibiotics, intramuscular (IM) injections and intravenous (IV) injections decreased while the use of hormones increased. No significant change of the average medicine expenditure per prescription was observed. Disparities among different levels of Health Care Institutions and different age groups existed.
The problems of poly-pharmacy, overuse of antibiotics, intramuscular (IM) injections and intravenous (IV) injections and hormones still existed, however mitigated after the implementation of The National Essential Medicine Policy and the Zero Mark-up Policy.
China’s health system has made many progress, but the rapidly increasing expenditure on medicines was an issue of concern [1,2]. In 2012, medicine expenditure took up 40.37% of Total Health Expenditure (THE) and the medicine expenditure grew faster than that of gross domestic product (GDP) since 1990 . This growth can be traced back to the market reform in 1980s that public Health Care Institutions (HCIs, refer to all kinds of facilities that provide health care services, including tertiary hospitals, secondary hospital and primary health care centers) could claim at least 15% of the medicine expenditure as revenue to compensate the reduction in government subsidies, which was regarded as one of the incentives on health providers to increase revenue by over-prescription . WHO estimated over half of all medicines were prescribed, dispensed or sold inappropriately . A systematic review found that irrational use of medicines in China was severe, featured with polypharmacy, overuse of antibiotics and overuse of injections .
After the full implementation of NEMP and Zero Mark-up Policy, Hangzhou city made moderate progress in in the rational prescription of medicines. Average number of medicines per prescription, average number of antibiotics per prescription and average number of IV injections per prescription were significantly reduced. Although no significant change was observed on the average number of IM injections, the proportion of prescription with IM injections decreased. Hormones, on the contrary, were witnessed a slight rise. In brief, the overuse of antibiotics, IV injections and IM injections were reduced and more efforts should be invested to reduce the overuse of hormones.
The rational use of medicines was improved while the impact on affordability of medicines was not revealed. However, the problem of polypharmacy, overuse of antibiotics, IM injections, IV injections and hormones still existed. The prescription pattern among different levels of HCIs indicated that primary and secondary HCIs might need further attention and intervention on the use of antibiotics. More actions should be adopted to control the use of IV injections and hormones in secondary and tertiary HCIs.