title: Evaluation, in three provinces, of the introduction and impact of China's National Essential Medicines Scheme.
abstract: OBJECTIVE
  To evaluate implementation of the National Essential Medicines Scheme (NEMS) in rural China.
  
  
  METHODS
  Two rural counties/districts in each of three provinces where NEMS had been implemented were surveyed. Information was collected from NEMS staff at the province, county/district, township and village levels; patients with chronic disease were also interviewed. Service provision, finances, prescriptions, inpatient records and the expenditures of patients with certain diagnoses were investigated in township hospitals and village clinics. The results were compared with the corresponding data recorded before NEMS was introduced.
  
  
  RESULTS
  Following the introduction of NEMS, drug procurement in each study location was systematized. Total drug costs declined. This, and improved prescribing, reduced the costs of outpatient and inpatient care and led, apparently, to increased uptake of health services. However, the prices of some drugs had increased and the availability of others had declined. The compensation of health-care providers for NEMS-related reductions in their incomes had been largely ineffective. As a result of the introduction of NEMS, health facilities relied more on public financing. Many health-care providers complained about higher workloads and lower incomes.
  
  
  CONCLUSIONS
  Although it was well conceived, the introduction of NEMS into China's decentralized, fee-for-service system of health care has not been straightforward. It has highlighted the problems associated with attempts to modernize health care and health financing for patients' benefit. Sustainable mechanisms to compensate health-care providers for lost income are needed to ensure that NEMS is a success.
authors.affiliation: National Center for Women and Children's Health, China Centers for Disease Control, Beijing, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Li
authors.forename: Cui
authors.initials: C
authors.lastname: Ying
authors.forename: Guo
authors.initials: G
authors.lastname: Sufang
authors.forename: Philippa
authors.initials: P
authors.lastname: Brant
authors.forename: Li
authors.initials: L
authors.lastname: Bin
authors.forename: David
authors.initials: D
authors.lastname: Hipgrave
mesh_terms: D001291:Attitude of Health Personnel; D001294:Attitude to Health; D002681:China; D002908:Chronic Disease; D003363:Cost Control / Q000379:methods; D016527:Drug Costs / Q000592:standards / Q000639:trends*; D005069:Evaluation Studies as Topic; D005380:Financing, Government; D018166:Health Care Reform / Q000191:economics* / Q000639:trends; D006801:Humans; D007407:Interviews as Topic; D009313:National Health Programs / Q000191:economics* / Q000458:organization & administration / Q000639:trends; D010820:Physicians / Q000191:economics* / Q000639:trends; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000639:trends; D055553:Prescription Drugs / Q000191:economics* / Q000592:standards / Q000600:supply & distribution; D036301:Qualitative Research; D019035:Rural Health Services / Q000191:economics / Q000458:organization & administration / Q000639:trends; D012456:Salaries and Fringe Benefits / Q000639:trends
chemical_list: D055553:Prescription Drugs