Longitudinal Trends in Medicine Supply, Price and Utilisation in Primary Care Facilities in Rural Southwestern China Under National Essential Medicines Policy (2012-2017): Disparities Across Facilities and Medicines
نویسندگان
1 Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
2 Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
3 School of Public Health, Fudan University, Shanghai, China
4 School of Public Health, The University of Hong Kong, Hong Kong SAR, China
5 School of Public Health, The University of Hong Kong, Hong Kong SAR, China
6 Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
7 Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
doi
10.34172/ijhpm.8991چکیده
Background The long-term impacts of the National Essential Medicines Policy (NEMP) in remote and rural areas of China remain underexplored. This study investigates the longitudinal trends in medicine supply, affordability, and utilisation in a rural county in Southwestern China from 2012 to 2017. Methods A quasi-experimental design was employed to analyse 108 111 purchase records covering 650 medicines from seven township health centres (THCs) and 73 village clinics. Drug supply was assessed by the available number of medicine types, utilisation by sales volume, and affordability using a Drug Price Index (DPI) based on a fixed basket of 344 medicines. Interrupted time-series analysis was then conducted to evaluate trends during the first-stage NEMP and to identify changes following the implementation of second stage in November 2015. Results Medicine number in rural primary care facilities increased steadily (+5.1 quarterly) during the first stage of NEMP, but exhibited abrupt and sustained drops (-2.1 quarterly) following the second-stage NEMP. DPIs exhibited gradual increases throughout both policy stages (+0.2% quarterly), while overall drug sales remained stable. Disaggregated by medicines, traditional Chinese medicines (TCMs) exhibited a faster increase in the available number than Western (chemical or biological) medicines and were associated with slower growth in DPI. By facility levels, village clinics experienced continuous declines in the number of Western medicines, accompanied by sharp increases in DPI. THCs also revealed a rising DPI in Western medicines, which consistently dominated overall drug sales. Conclusions Primary care facilities in rural Southwestern China experienced relatively stable medicine supply and utilisation, alongside rising medicine prices, over the long-term implementation of NEMP. Significant disparities and structural changes across facility tiers and medicine categories underscore the urgent need to address the pressing challenges of the declining availability and increasing costs of Western medicines in rural village clinics.
