title: Short-term differences in drug prices after implementation of the national essential medicines system: A case study in rural Jiangxi Province, China.
abstract: OBJECTIVE
  China's 2009 national essential medicine system (NEMS) was designed to reduce prices through a zero-markup policy and a centralized bidding system. To analyze NEMS's short-term impact on drug prices, we estimated the retail and wholesale prices before and after the reform at health institutions in rural Jiangxi Province.
  
  
  METHODS
  We undertook two cross-sectional surveys of prices of 39 medicines in November 2008 and May 2010, calculated inflation adjusted prices, and used the Wilcoxon signed-rank and rank-sum tests to examine price changes at different health institutions.
  
  
  RESULTS
  Retail prices at pilot (P < 0.01) and nonpilot (P < 0.01) township health centers decreased significantly, whereas the declines at retail pharmacies (P = 0.57) and village clinics (P = 0.29) were insignificant. The decline at pilot township health centers was the largest, compared with other kinds of health institutions (P < 0.01). Retail prices of essential and non-essential medicines declined significantly at pilot facilities (P < 0.05); price drops for non-essential medicines occurred only at pilot facilities (P < 0.05). No significant decline of wholesale prices were found at pilot (P = 0.86) and nonpilot units (P = 0.18), retail pharmacies (P = 0.18), and village clinics (P = 0.20). The wholesale prices changes at pilot units before and after the reform were higher than at nonpilot public units (P < 0.05), retail pharmacies (P < 0.05), and village clinics (P < 0.05).
  
  
  CONCLUSIONS
  While the NEMS zero-markup policy significantly reduced retail prices at pilot health institutions, the centralized bidding system was insufficient to lower wholesale prices. A drug price management system should be constructed to control medicine prices and a long-term price information system is needed to monitor price changes.
authors.affiliation: Collaborative Innovation Center of Health Risks Governance, School of Public Health, Fudan University, Shanghai, China ; Department of Preventive Medicine, Health Development and Policy Research Center, Jiangxi University of Traditional Chinese Medicine, Nanchang, China.
authors.forename: Junyong
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Preventive Medicine, Health Development and Policy Research Center, Jiangxi University of Traditional Chinese Medicine, Nanchang, China.
authors.forename: Xia
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of Preventive Medicine, Health Development and Policy Research Center, Jiangxi University of Traditional Chinese Medicine, Nanchang, China.
authors.forename: Suzhen
authors.initials: S
authors.lastname: Wang
authors.affiliation: Department of Preventive Medicine, Health Development and Policy Research Center, Jiangxi University of Traditional Chinese Medicine, Nanchang, China.
authors.forename: Heli
authors.initials: H
authors.lastname: Chen
authors.affiliation: Department of Circulation Supervision for Medicine and Cosmetics, Jiangxi's Department of Food and Drug Supervision and Administration, Nanchang, China.
authors.forename: Xun
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Circulation Supervision for Medicine and Cosmetics, Jiangxi's Department of Food and Drug Supervision and Administration, Nanchang, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhou
authors.affiliation: Department of Preventive Medicine, Health Development and Policy Research Center, Jiangxi University of Traditional Chinese Medicine, Nanchang, China.
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Preventive Medicine, Health Development and Policy Research Center, Jiangxi University of Traditional Chinese Medicine, Nanchang, China.
authors.forename: Yanchen
authors.initials: Y
authors.lastname: Zhu
authors.affiliation: Department of Preventive Medicine, Health Development and Policy Research Center, Jiangxi University of Traditional Chinese Medicine, Nanchang, China.
authors.forename: Xianping
authors.initials: X
authors.lastname: Zheng
authors.affiliation: Collaborative Innovation Center of Health Risks Governance, School of Public Health, Fudan University, Shanghai, China.
authors.forename: Mo
authors.initials: M
authors.lastname: Hao
mesh_terms: D002681:China; D003430:Cross-Sectional Studies; D016527:Drug Costs; D018954:Drugs, Essential / Q000191:economics* / Q000600:supply & distribution; D006291:Health Policy / Q000191:economics*; D006801:Humans; D019035:Rural Health Services / Q000191:economics; D018709:Statistics, Nonparametric
chemical_list: D018954:Drugs, Essential
keywords: China; drug prices; healthcare reform; national essential medicine system; rural healthcare