Access to Essential Medicine in China

Access to Essential Medicines in China

Introduction to Essential Medicines

Essential medicines (EMs) are medicines that address the priority health care needs of the population. They are selected with regards to public health relevance, evidence on efficacy and safety and comparative cost-effectiveness. Establishing a national essential medicines list (NEML) is a core element to national pharmaceutical policy. As the largest developing country with the population of more than 1.34 billion and medicines accounting for over 40% of total health expenditure, promoting essential medicines use in China is extremely important. China's public health facilities sell medicines for profit with a markup of 15%. Over 45% of total income in public health facilities in 2009 was generated by using and selling medicines (Abbott, 2005).

The high medicine expenditure was indeed attributable to irrational use of medicines and prescriber's preference of high price medicines over low price genenics. The use and access of medicines could be improved by proper selection and implementation of a national essential medicines list (NEML). In the latest health reform initiated in 2008, the government made a commitment to provide basic health care, including essential medicines, to all by 2020. This paper describes and identifies the progress and challenges in the essential medicines selection from 1979 to 2010 (Goodwin, 2008). We compare the latest NEML to the WHO model list in terms of medicine inclusion criteria and selection procedures (Weber, 2010). We use these as a basis to provide suggestions on how to improve essential medicines selection in China.

History of Essential Medicines in China

Following the resolution of World Health Assembly in 1978 which urged WHO member states to establish their own list of EMs, the Chinese government introduced the concept in 1979. An expert group to select medicines for the National Essential Medicines List (NEML) was established by Chinese Ministry of Health (MOH) and former State Food and Drug Administration (SFDA). The first edition of NEML was produced in 1982 with 278 western medicines (Goodwin, 2008).

A committee which acted as overall managing authority for the selection of NEML was assembled in 1992. It included representative from the Ministry of Health and three other government departments. In 1996, it issued the first revised list which increased the number of medicines in the essential medicine list to 2398 medicines (Hong, 2000). The list contained 699 modern medicines and 1699 Traditional Chinese Medicines (TCMs). From 1998 to 2004 I, the NEML was revised every two years. During this time the NEML served as a base for the selection of social health insurance medicines lists. From 2004 the NEML ceased updating until the latest NEML was released in 2009. The changes of NEML from 1982 to 2004 are summarized in Table 1.

A number of studies quoted that the NEML was not successful in promoting the use of EMs and the accessibility of the medicines. The principle which stated that NEML should include 40%-50% registered medicines was accountable for the sharp expansion of the list. During this period, health providers' preference ...