HPR33 Short- and Long-Term Impacts of the National Essential Medicines Policy on Drug in Rural China

Abstract

<h2>Objectives</h2><p>The National Essential Medicines Policy (NEMP) has implemented in China for over 15 years; however, empirical evidence regarding its long-term impacts is lacking. We aim to assess short- and long-term effects of NEMP on drug availability, pricing, and usage in a deprived rural county in southwestern China.</p><h2>Methods</h2><p>We employed quasi-experimental design featuring a single-group pre-post- comparison. In total, 74,436 purchase records were collected from local healthcare facilities (2009-2016). Pharmaceutical data were analyzed semi-annually. Drug Price Index was calibrated for prices of a basket of drugs. We applied interrupted time-series analysis to examine the immediate and sustained impacts of the first stage (since January 2011) and second stage (since December 2015) NEMP.</p><h2>Results</h2><p>After NEMP, the available number of essential medicines rose by 77 but experienced a long-term decline (-17.7 per period) in township healthcare centers (THCs); in county hospitals, drug availability decreased by 45 but later exhibited a continuous increase (+9.9 per period). For prices, THCs underwent abrupt (-24.8%/-14.5% in retail/wholesale price) and sustained (-0.4%/-0.5% per period) reductions after NEMP. Similar price changes were also observed in county hospitals. For sales, significant disparity in the long-term change was found between THCs (+1.5% per period) and county hospitals (+7.6% per period). The 2^nd-stage NEMP further decreased retail prices in county hospitals, but subsequently showed upward trends in prices and sales in THCs and county hospitals. Finally, the impacts of NEMP could vary across therapeutical classifications of medicines.</p><h2>Conclusions</h2><p>NEMP effectively managed drug prices in primary and secondary care facilities in rural areas over short- and long-terms. Nevertheless, noticeable disparities in medicine utilization and sales were detected between rural THCs and county hospitals over time. Ongoing monitoring is imperative, and more attention should focus on the disproportionate impacts of policy on different pharmaceuticals, facility levels, regions, and populations.</p>