Availability and use of essential medicines in China: manufacturing, supply, and prescribing in Shandong and Gansu provinces.
BACKGROUND
The current health care reform in China launched in 2009 tackles the problem of access to appropriate medicines for its 1.3 billion people by focusing on providing essential medicines to all. To provide evidence for the reform process, we investigated the manufacturing, purchasing, and prescribing of essential medicines in two provinces.


METHODS
We conducted surveys in 2007 of all manufacturers (n = 253) and of 59 purposively selected retail and 63 hospital pharmacies in Shandong and Gansu provinces to assess production and supply of products on the 2004 National Essential Medicines List (NEML), as well as factors underlying decision making about production and supply. We also reviewed prescriptions (n = 5456) in health facilities to calculate standard indicators of appropriate medicines use.


RESULTS
Overall, manufacturers in Shandong and Gansu produced only 62% and 50%, respectively, of the essential medicines they were licensed to produce. Of a randomly selected 10% of NEML products, retail pharmacies stocked up to 60% of Western products. Median availability in hospital pharmacies ranged from 19% to 69%. Manufacturer and retail pharmacy managers based decisions on medicines production and stocking on economic considerations, while hospital pharmacy managers cited clinical need. Between 64% and 86% of prescriptions contained an essential medicine. However, overprescribing of antibiotics (34%-77% of prescriptions) and injectables (22%-61%) for adult non-infectious outpatient consultations was common.


CONCLUSIONS
We found that manufacturers, retail pharmacies, and hospital pharmacies paid limited attention to China's 2004 NEML in their decisions to manufacture, purchase, and stock essential medicines. We also found that prescribing of essential medicines was frequently inappropriate. These results should inform strategies to improve affordable access to essential medicines under the current health care reform.
Chen
Wen
W
Department of Health Economics, School of Public Health, Fudan University and Key Laboratory of Public Health and Safety, Ministry of Education, 138 Yi Xue Yuan Road, Shanghai 200032, China. wenchen@fudan.edu.cn
Tang
Shenglan
S
Sun
Jing
J
Ross-Degnan
Dennis
D
Wagner
Anita K
AK
D000288:Administrative Personnel; D000328:Adult; D002681:China; D003132:Commerce / Q000706:statistics & numerical data; D003625:Data Collection; D004345:Drug Industry / Q000706:statistics & numerical data; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D017723:Drug Utilization Review; D004365:Drugs, Chinese Herbal / Q000600:supply & distribution; D018954:Drugs, Essential / Q000191:economics / Q000600:supply & distribution*; D006297:Health Services Accessibility; D006300:Health Services Misuse / Q000706:statistics & numerical data; D006801:Humans; D007407:Interviews as Topic; D010594:Pharmacies / Q000706:statistics & numerical data; D010595:Pharmacists; D010602:Pharmacopoeias as Topic; D010607:Pharmacy Service, Hospital / Q000706:statistics & numerical data
D004365:Drugs, Chinese Herbal; D018954:Drugs, Essential