title: The effect of the National Essential Medicines Policy on health expenditures and service delivery in Chinese township health centres: evidence from a longitudinal study.
abstract: OBJECTIVE
  The government of China has introduced a National Essential Medicines Policy (NEMP) in the new round of health system reform. The objective of this paper is to analyse whether the NEMP can play a role in curbing the rise of medical expenditures without disrupting the availability of healthcare services at township hospitals in China.
  
  
  METHODS
  This study adopted a pre-post treatment-control study design. A difference-in-differences method and fixed-effects model for panel data were employed to estimate the effect of the NEMP.
  
  
  METHODS
  Chongqing, Jiangsu and Henan Province, in China, in 2009 and 2010.
  
  
  METHODS
  296 township health centres.
  
  
  METHODS
  Outcomes for health expenditures were average outpatient drug expenses per visit, average inpatient drug expenses per discharged patient, average outpatient expenses per visit and average inpatient expenses per discharged patient. Outcomes for care delivery were the numbers of visits per certified doctor per day and the numbers of hospitalised patients per certified doctor per day.
  
  
  RESULTS
  The township health centres that were enrolled in the NEMP reported 26% (p<0.01) lower drug expenditures for inpatient care. An 11% (p<0.05) decrease in average inpatient expenditures per discharged patient was found following the implementation of the NEMP. The impacts of the NEMP on average outpatient expenditures and outpatient drug expenditures were not statistically significant at the 5% level. No statistically significant associations were found between the NEMP and reduction in quantity of health service delivery.
  
  
  CONCLUSIONS
  The NEMP was significant in its effect in reducing inpatient medication and health service expenditures. This study shows no evidence that the quantity of healthcare service declined significantly after introduction of the NEMP over the study period, which suggests that if appropriate matching policies are introduced, the side effects of the NEMP can be counteracted to some degree. Further research including a long-term follow-up study is needed.
authors.affiliation: Harbin Medical University, Harbin, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Harbin Medical University, Harbin, China.
authors.forename: Qunhong
authors.initials: Q
authors.lastname: Wu
authors.affiliation: Harbin Medical University, Harbin, China.
authors.forename: Guoxiang
authors.initials: G
authors.lastname: Liu
authors.affiliation: Harbin Medical University, Harbin, China.
authors.forename: Ye
authors.initials: Y
authors.lastname: Li
authors.affiliation: Harbin Medical University, Harbin, China.
authors.forename: Lijun
authors.initials: L
authors.lastname: Gao
authors.affiliation: Harbin Medical University, Harbin, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Guo
authors.affiliation: Harbin Medical University, Harbin, China.
authors.forename: Wenqi
authors.initials: W
authors.lastname: Fu
authors.affiliation: Harbin Medical University, Harbin, China.
authors.forename: Yanhua
authors.initials: Y
authors.lastname: Hao
authors.affiliation: Harbin Medical University, Harbin, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Cui
authors.affiliation: Harbin Medical University, Harbin, China.
authors.forename: Weidong
authors.initials: W
authors.lastname: Huang
authors.affiliation: University of Toronto, Toronto, Canada.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Coyte
mesh_terms: D002681:China; D003695:Delivery of Health Care / Q000458:organization & administration*; D004335:Drug and Narcotic Control / Q000379:methods*; D018954:Drugs, Essential / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D018166:Health Care Reform / Q000379:methods*; D005102:Health Expenditures / Q000331:legislation & jurisprudence*; D006291:Health Policy; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D019037:Urban Health Services / Q000458:organization & administration*
chemical_list: D018954:Drugs, Essential
keywords: HEALTH ECONOMICS; HEALTH SERVICES ADMINISTRATION & MANAGEMENT; PRIMARY CARE