title: Evaluation of the implementation outcomes of the Essential Medicines System in Anhui county-level public hospitals: a before-and-after study.
abstract: BACKGROUND
  In August 2009, China formally established the National Essential Medicines System (NEMS) and implemented this system in the government-funded primary care medical and health institutions. After nearly four years of practice, the system has already been generalized to the county-level public hospitals. This study aimed to examine the impact on the operation of the hospitals through implementing the NEMS in Anhui Province and put forward some improvement measures.
  
  
  METHODS
  For quantitative analyses, we distributed 21 questionnaires to 21 county-level public hospitals in Anhui Province, which had implemented the national public hospital reform. Twenty valid questionnaires were returned, response rate was 95.2 %. Questions covered storage, usage and supply of essential medicines, compensation mechanisms, insurance policies, hospital incomes, service amounts and fees from January to June in each of the years from 2011 to 2013. For qualitative study, we chose three from 21 hospitals based on geographical distribution and conducted focus group interviews based on a planned interview outline centered on the implementation status of the system.
  
  
  RESULTS
  Following implementation, the types of essential medicines stocked and the proportion of total sales that were composed of essential medicines have increased but do not yet meet the required standards issued in the government document, which was not less than 95 % and 30 % of the total, respectively. The average financial subsidies had increased by 1,665,200 yuan, and significant increases appeared in provincial financial assistance. The average inpatient fees per visit decreased by 487.41 yuan. Increases in income from medicines during hospitalization led to increases in per-visit hospitalization fees. Unexpectedly, higher financial assistance revenue also led to higher average per-visit hospitalization fees.
  
  
  CONCLUSIONS
  The guiding role of the National Essential Medicines List remains to be reinforced, and specific lists for county hospitals should be developed. Supervision was required to implement the process of guaranteeing the storage and usage of essential medicines. The compensation mechanism was far from sound, and the leverage of the health insurance policies was not obvious. Regarding the reductions in the proportion of income derived from medicines and per-visit inpatient fees, the policy had been partially successful.
  
  
  CONCLUSIONS
  Our results showed that the implementation of the Essential Medicines System do have a beneficial role in the reduction of the drug fees and further alleviates the burden of the masses. Much effort should be made to the redesign of the compensation mechanism, mainly including the government and the medical insurance compensation, emphasizing on both the fairness and the rationality of the compensation in the future.
authors.affiliation: Guangdong Women and Children Hospital, 521 Xingnan Road, Guangzhou, Guangdong, 511442, P.R. China. siyecao1218@163.com.
authors.forename: Shuman
authors.initials: S
authors.lastname: Xu
authors.affiliation: The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, Anhui, 230022, P.R. China. 479767345@qq.com.
authors.forename: Cheng
authors.initials: C
authors.lastname: Bian
authors.affiliation: The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, Anhui, 230022, P.R. China. wangheng1969@163.com.
authors.forename: Heng
authors.initials: H
authors.lastname: Wang
authors.affiliation: The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, Anhui, 230022, P.R. China. 455942001@qq.com.
authors.forename: Niannian
authors.initials: N
authors.lastname: Li
authors.affiliation: The Fourth Affiliated Hospital of Anhui Medical University, 372 Tunxi Road, Hefei, Anhui, 230000, P.R. China. 592818068@qq.com.
authors.forename: Jingya
authors.initials: J
authors.lastname: Wu
authors.affiliation: The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, Anhui, 230022, P.R. China. 445869000@qq.com.
authors.forename: Peng
authors.initials: P
authors.lastname: Li
authors.affiliation: Anhui Provincial Hospital, 17 Lujiang Road, Hefei, Anhui, 230001, P.R. China. luhua1986@163.com.
authors.forename: Hua
authors.initials: H
authors.lastname: Lu
mesh_terms: D002681:China; D018954:Drugs, Essential / Q000600:supply & distribution*; D005249:Fees and Charges; D017144:Focus Groups; D018166:Health Care Reform / Q000191:economics; D006291:Health Policy / Q000191:economics; D006297:Health Services Accessibility; D006779:Hospitals, Public / Q000191:economics; D006801:Humans; D007182:Income; D007348:Insurance, Health / Q000191:economics; D007407:Interviews as Topic; D015397:Program Evaluation; D036301:Qualitative Research; D011795:Surveys and Questionnaires
chemical_list: D018954:Drugs, Essential