Measuring access to medicines: a survey of prices, availability and affordability in Shaanxi province of China.
OBJECTIVE
To measure the prices and availability of selected medicines in Shaanxi Province after the implementation of new healthcare reform in 2009.


METHODS
Data on the prices and availability of 47 medicines were collected from 50 public and 36 private sector medicine outlets in six regions of Shaanxi Province, Western China using a standardized methodology developed by the World Health Organization and Health Action International from September to October 2010. Medicine prices were compared with international reference prices to obtain a median price ratio. Affordability was measured as the number of days' wages required for the lowest-paid unskilled government worker to purchase standard treatments for common conditions.


RESULTS
The mean availabilities of originator brands and lowest-priced generics were 8.9% and 26.5% in the public sector, and 18.1% and 43.6% in the private sector, respectively. The public sector procured generics and originator brands at median price ratios of 0.75 and 8.49, respectively, while patients paid 0.97 and 10.16. Final patient prices for lowest-priced generics and originator brands in the private sector were about 1.53 and 8.36 times their international retail prices, respectively. Public sector vendors applied high markups of 30.4% to generics, and 19.6% to originator brands. In the private sector, originator brands cost 390.7% more, on average, than their generic equivalents. Generic medicines were priced 17.3% higher in the private sector than the public sector. The lowest-paid government worker would need 0.1 day's wages to purchase captopril for lowest-priced generics from private sector, while 6.6 days' wages for losartan. For originator brands, the costs rise to 1.2 days' wages for salbutamol inhaler and 15.6 days' wages for omeprazole.


CONCLUSIONS
The prices, availability and affordability of medicines in China should be improved to ensure equitable access to basic medical treatments, especially for the poor. This requires multi-faceted interventions, as well as the review and refocusing of policies, regulations and educational interventions.
Department of Pharmacy Administration, School of Pharmacy, Health Science Centre, Xi'an Jiaotong University, Xi'an, China.
Minghuan
M
Jiang
Shimin
S
Yang
Kangkang
K
Yan
Jun
J
Liu
Jun
J
Zhao
Yu
Y
Fang
D002681:China; D003132:Commerce / Q000706:statistics & numerical data*; D003625:Data Collection; D011307:Drug Prescriptions / Q000191:economics / Q000706:statistics & numerical data; D006291:Health Policy / Q000191:economics; D006297:Health Services Accessibility / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D004364:Pharmaceutical Preparations / Q000191:economics*; D017149:Private Sector / Q000191:economics / Q000706:statistics & numerical data; D017150:Public Sector / Q000191:economics / Q000706:statistics & numerical data
D004364:Pharmaceutical Preparations