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

Document Type : Original Article

Authors

1 Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China

2 School of Public Health, The University of Hong Kong, Hong Kong SAR, China

3 Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China

4 School of Public Health, Fudan University, Shanghai, China

Abstract

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.

Keywords

References

  1. Sripa P, Hayhoe B, Garg P, Majeed A, Greenfield G. Impact of GP gatekeeping on quality of care, and health outcomes, use, and expenditure: a systematic review. Br J Gen Pract. 2019;69(682):e294-e303. doi:3399/bjgp19X702209
  2. Tharumia Jagadeesan C, Wirtz VJ. Geographical accessibility of medicines: a systematic literature review of pharmacy mapping. J Pharm Policy Pract. 2021;14(1):28. doi:1186/s40545-020-00291-7
  3. Weinhold I, Gurtner S. Understanding shortages of sufficient health care in rural areas. Health Policy. 2014;118(2):201-214. doi:1016/j.healthpol.2014.07.018
  4. World Health Organization (WHO). Global Spending on Health: Rising to the Pandemic’s Challenges. WHO; 2022. https://iris.who.int/bitstream/handle/10665/365133/9789240064911-eng.pdf.
  5. Laing R, Waning B, Gray A, Ford N, 't Hoen E. 25 years of the WHO essential medicines lists: progress and challenges. Lancet. 2003;361(9370):1723-1729. doi:1016/s0140-6736(03)13375-2
  6. Das P, Horton R. Essential medicines for universal health coverage. Lancet. 2017;389(10067):337-339. doi:1016/s0140-6736(16)31907-9
  7. Eggleston K, Ling L, Qingyue M, Lindelow M, Wagstaff A. Health service delivery in China: a literature review. Health Econ. 2008;17(2):149-165. doi:1002/hec.1306
  8. Yip W, Fu H, Chen AT, et al. 10 years of health-care reform in China: progress and gaps in universal health coverage. Lancet. 2019;394(10204):1192-1204. doi:1016/s0140-6736(19)32136-1
  9. Hu S. Essential medicine policy in China: pros and cons. J Med Econ. 2013;16(2):289-294. doi:3111/13696998.2012.751176
  10. Li Y, Ying C, Sufang G, Brant P, Bin L, Hipgrave D. Evaluation, in three provinces, of the introduction and impact of China's National Essential Medicines Scheme. Bull World Health Organ. 2013;91(3):184-194. doi:2471/blt.11.097998
  11. Song Y, Bian Y, Petzold M, Li L, Yin A. Effects of the national essential medicine system in reducing drug prices: an empirical study in four Chinese provinces. J Pharm Policy Pract. 2014;7(1):12. doi:1186/2052-3211-7-12
  12. Song Y, Bian Y, Petzold M, Li L, Yin A. The impact of China's national essential medicine system on improving rational drug use in primary health care facilities: an empirical study in four provinces. BMC Health Serv Res. 2014;14:507. doi:1186/s12913-014-0507-3
  13. Tie-min Z, Yu-hui Z, Quan W, et al. The Results and Analysis of National Health Accounts in China in 2018. Chinese Health Economics. 2020; 39(6):5-8. doi:7664/CHE20200601
  14. OECD. Health at a Glance 2011: OECD Indicators. Vol 15. OECD Publishing; 2015.
  15. Xiao Y, Zhao K, Bishai DM, Peters DH. Essential drugs policy in three rural counties in China: what does a complexity lens add? Soc Sci Med. 2013;93:220-228. doi:1016/j.socscimed.2012.09.034
  16. Fang Y, Wagner AK, Yang S, Jiang M, Zhang F, Ross-Degnan D. Access to affordable medicines after health reform: evidence from two cross-sectional surveys in Shaanxi province, western China. Lancet Glob Health. 2013;1(4):e227-e237. doi:1016/s2214-109x(13)70072-x
  17. Chen Z, Li S, Choonara I, et al. Accessibility of essential medicines for children in Sichuan province of China: a cross-sectional study. Front Pharmacol. 2022;13:828152. doi:3389/fphar.2022.828152
  18. Zhang M, Zou K, Liu Z, et al. Availability of essential medicines, progress and regional distribution in China: a systematic review and meta-analysis. Front Public Health. 2023;11:1149838. doi:3389/fpubh.2023.1149838
  19. Xiao Y, Wang J, Shen P, Zheng B, Zheng Y, Li L. Retrospective survey of the efficacy of mandatory implementation of the Essential Medicine Policy in the primary healthcare setting in China: failure to promote the rational use of antibiotics in clinics. Int J Antimicrob Agents. 2016;48(4):409-414. doi:1016/j.ijantimicag.2016.06.017
  20. Yang L, Liu C, Ferrier JA, Zhang X. Organizational barriers associated with the implementation of national essential medicines policy: a cross-sectional study of township hospitals in China. Soc Sci Med. 2015;145:201-208. doi:1016/j.socscimed.2015.08.044
  21. Guo Z, Guan X, Shi L. The impacts of implementation of National Essential Medicines Policies on primary healthcare institutions: a cross-sectional study in China. BMC Health Serv Res. 2017;17(1):723. doi:1186/s12913-017-2698-x
  22. Yang C, Hu S, Ye D, Jiang M, Babar ZU, Fang Y. Evaluating price and availability of essential medicines in China: a mixed cross-sectional and longitudinal study. Front Pharmacol. 2020;11:602421. doi:3389/fphar.2020.602421
  23. Liu Z, Zou K, Liu D, et al. The price and affordability of essential medicines, progress and regional distribution in China: a systematic review. Front Pharmacol. 2023;14:1153972. doi:3389/fphar.2023.1153972
  24. Zhou X, Zhang X, Yang L, et al. Influencing factors of physicians' prescription behavior in selecting essential medicines: a cross-sectional survey in Chinese county hospitals. BMC Health Serv Res. 2019;19(1):980. doi:1186/s12913-019-4831-5
  25. Wu D, Lam TP, Lam KF, Sun KS, Zhou XD. Patients' coping behaviors to unavailability of essential medicines in primary care in developed urban China. Int J Health Policy Manag. 2021;10(1):14-21. doi:15171/ijhpm.2020.09
  26. Xiong X, Huo Z, Zhou S, et al. Short- and long-term impacts of the national essential medicines policy on drug availability, price, and usage in a deprived rural county in southwestern China: an interrupted time series analysis across 8 years. Front Public Health. 2024;12:1355239. doi:3389/fpubh.2024.1355239
  27. Xiong X, Luo L, Zhou S, Li VJ, Zhou Y, Huo Z. A profile of patients' and doctors' perceptions, acceptance, and utilization of e-health in a deprived region in southwestern China. PLOS Digit Health. 2023;2(4):e0000238. doi:1371/journal.pdig.0000238
  28. WHO Collaborating Centre for Drug Statistics Methodology. ATC/DDD Index 2023. https://www.whocc.no/atc_ddd_index/.
  29. Wynne MA, Sigalla FD. The consumer price index. Federal Reserve Bank of Dallas Economic Review. 1994;2:1-22.
  30. Balk BM. Decompositions of Fisher indexes. Econ Lett. 2004;82(1):107-113. doi:1016/j.econlet.2003.09.006
  31. Wagner AK, Soumerai SB, Zhang F, Ross-Degnan D. Segmented regression analysis of interrupted time series studies in medication use research. J Clin Pharm Ther. 2002;27(4):299-309. doi:1046/j.1365-2710.2002.00430.x
  32. Jandoc R, Burden AM, Mamdani M, Lévesque LE, Cadarette SM. Interrupted time series analysis in drug utilization research is increasing: systematic review and recommendations. J Clin Epidemiol. 2015;68(8):950-956. doi:1016/j.jclinepi.2014.12.018
  33. Beck N, Katz JN. What to do (and not to do) with time-series cross-section data. Am Polit Sci Rev. 1995;89(3):634-647. doi:2307/2082979
  34. Bottomley C, Scott JA, Isham V. Analysing interrupted time series with a control. Epidemiol Methods. 2019;8(1):20180010. doi:1515/em-2018-0010
  35. Li Q, Chen F, Yang M, et al. The effect of China's national essential medicine policy on health expenses: evidence from a national study. Inquiry. 2018;55:46958018787057. doi:1177/0046958018787057
  36. Yao Q, Liu C, Ferrier JA, Liu Z, Sun J. Urban-rural inequality regarding drug prescriptions in primary care facilities - a pre-post comparison of the National Essential Medicines Scheme of China. Int J Equity Health. 2015;14:58. doi:1186/s12939-015-0186-7
  37. Guan X, Hu H, Man C, Shi L. A survey of availability, price and affordability of essential medicines from 2011 to 2016 in Chinese secondary and tertiary hospitals. Int J Equity Health. 2018;17(1):158. doi:1186/s12939-018-0870-5
  38. Rong X, Yin J, Duan S, Sun Q, Babar ZU. The effects of pricing policy on the prices and supply of low-cost medicines in Shandong, China: evidence from an interrupted time series analysis. BMC Public Health. 2020;20(1):588. doi:1186/s12889-020-08746-x
  39. Selvaraj S, Farooqui HH, Mehta A, Mathur MR. Evaluating the impact of price regulation (Drug Price Control Order 2013) on antibiotic sales in India: a quasi-experimental analysis, 2008-2018. J Pharm Policy Pract. 2022;15(1):68. doi:1186/s40545-022-00466-4
  40. Cameron A, Ewen M, Ross-Degnan D, Ball D, Laing R. Medicine prices, availability, and affordability in 36 developing and middle-income countries: a secondary analysis. Lancet. 2009;373(9659):240-249. doi:1016/s0140-6736(08)61762-6
  41. World Health Organization (WHO). Measuring Medicine Prices, Availability, Affordability and Price Components. WHO; 2008.
  42. Wang X, He X, Ren Y, et al. Evaluating the price, availability, and affordability of essential medicines in primary healthcare institutions: a mixed longitudinal and cross-sectional study in Jiangsu, China. Front Public Health. 2022;10:860471. doi:3389/fpubh.2022.860471
  43. World Health Organization (WHO). Continuity and Coordination of Care: A Practice Brief to Support Implementation of the WHO Framework on Integrated People-Centred Health Services. WHO; 2018.

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History

  • Received Date: 13 January 2025
  • Revised Date: 29 August 2025
  • Accepted Date: 17 November 2025
  • First Published Date: 17 November 2025
  • Published Date: 01 December 2025

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