Analysis on the Effect of the National Essential Medicine System
in Rural Township Health Clinics
—Based on the Survey Data from Rugao City in Jiangsu Province
Ming-fang Wang
College of Engineering, Nanjing Agricultural University
Nanjing, China
wmfxhbl@sina.com
Abstract - To understand the present situation of
implementation of the national essential medicine system
in rural primary health care sectors of China, the economic
impact on rural residents with the implementation of
essential medicine system is analyzed to provide a reference
to improve the national essential medicine system. The study
investigates 48 township health clinics in Rugao City,
Jiangsu Province and analyzes the survey data by the
method of descriptive statistics and inferential statistics. The
township health clinics take on a phenomenon called “one up
and two down” after the implementation of essential drugs.
The paper points out that a sound compensation mechanism
of the primary health care sectors should be established by
the relevant departments. Focusing on the effect of publicity,
the publicity of the national medicine system needs to be
improved and the training and education on the use of
essential drugs should be enhanced.
Keywords - Township health clinics, national essential
medicine system, essential drugs, drugs to support medical
I. INTRODUCTION
The problems of “Agriculture, Rural areas and
Farmers” is the fundamental ones of the party and state, in
which rural health work is directly related to the
protection of rural productive forces, the revitalization of
the rural economy and the maintenance of coordinated
development of rural society. It is also related to the
improvement of the living quality of farmers and the
social progress in rural areas. By implementation the
essential medicine system in rural areas, being fully
equipped with essential drugs and carrying out the zero
sales slips, this system will cover more people and
achieve greater effectiveness. It is significant for the
majority of the villagers to ensure equitable access to safe,
economical and effective essential drugs, to control drugs
cost, to reduce the economic burden of diseases, and to
avoid the poverty caused by illness [1]. Township health
clinics, which are the public welfare and health services
agencies held by County Government, are the hub of the
three-tier level health care network in rural county,
township and village [2]. In order to understand the
implementation of the national essential medicine system
____________________
Funded projects, subsidized by Central universities, research and
operating expenses and Nanjing Agricultural University
Humanities and Social Sciences. (Item Number is SK21100020)
in rural areas, the research group visited some township
health clinics in rural areas and conducted surveys to
study and analyze the impact of the implementation of
national essential medicine system on township health
clinics operation.
II. RESEARCH OBJECTS AND METHODOLGY
A. Research Objects
Researches on the essential drugs operating
conditions from August to December in 2010 and from
August to December in 2011 are carried out in rural
primary health care sectors. The survey was conducted in
48 township health clinics in Rugao City, Jiangsu
Province obtain the relevant data including the outpatient
data which include the total income of outpatients,
outpatient drugs income, outpatient essential drugs
income and the inpatient data which include the total
income of inpatients, inpatient drugs income, inpatient
essential drugs income and so on. In order to understand
the implementation of the national essential medicine
system in rural areas, 48 township Health Clinics are
divided into two groups. One group consists of 14
township health clinics which started a pilot
implementation of the national essential medicine system and
universally accessed to essential drugs in August 2011.
The other group consists of 34 township health clinics
which started to universal essential drugs from August
2011 without the pilot.
B. The survey methodology and data processing
The data used in this study come from statistical data
and interviews by the research group’s site investigation.
Some other data come from the administrative department
of health website. The survey data is processed by
Spss17.0 package [3]. The methodology combining
descriptive statistics [4] and inferential statistics [5] is used
to analyze the quantitative data. The methodology of
classification, induction and extraction is used to analyze
the qualitative data by topic.
III. SURVEY RESULTS AND ANALYSIS
A. Analysis the results of survey data from 14 township
health clinics
The output results shown in table Ⅰ are gotten by
statistical analysis and differences comparative analysis
on the survey data about the outpatients and inpatients,
total income, drugs income, medical income and so on
from August to December in 2010 when the essential
drugs is piloted and from August to December in 2011
when the essential drugs is popularized.
TABLEⅠ Paired Samples Statistics and Test
pilot
popularized
difference between
pilot and popularized
t-value
p-value
outpatients
2541.429
3546.014
-1004.586
-2.967
0.011
inpatients
90.357
99.300
-8.943
-2.046
0.062
106.998
78.549
28.449
3.572
0.003
65.580
41.131
24.449
4.840
0.000
3145.735
3133.163
12.572
0.109
0.915
1951.871
1930.946
20.924
0.211
0.837
total outpatient expenditures each person
outpatient drugs expenditures each person
total inpatient expenditures each person
inpatient drugs expenditures each person
Table Ⅰ shows that, comparing with the data about
pilot, the outpatients increased 1015 per month after the
national essential medicine system is popularized. The
total outpatient expenditure for each person decreased
28.448yuan than that in the pilot. In which the outpatient
drugs expenditure decreased 24.449yuan for each person
than that in the pilot. The P-values which are 0.011,
0.003, 0.000 respectively in comparison and contrast test
are less than 0.05. Therefore it can be inferred that the
changes about the data of outpatients after the national
essential medicine system is popularized are significant
comparing with that in the pilot. Similarly, the data about
inpatients increased 9 people while the total inpatient
expenditure for each person decreased 12.572yuan than
that in the pilot. Among them, the inpatient drugs
expenditures decreased 20.924yuan for each person than
that in the pilot. The P-values which are 0.062,
0.915, 0.837 respectively in comparison and contrast test
are more than 0.05. Therefore it can be inferred that the
changes about the data of inpatients after the national
essential medicine system is popularized are not
significant comparing with the pilot.
B. Analysis the results of survey data about 34
township health clinics
The output results shown in table Ⅱ are gotten by
statistical analysis and differences comparative analysis
on the survey data such as the outpatients and inpatients,
total income, drugs income, medical income from August
to December in 2010 when the essential drugs is not
popularized and from August to December in 2011 when
the essential drugs is popularized.
TABLE Ⅱ Paired Samples Statistics and Test
nonpopularized
popularized
difference between
non-popularized and
popularized
t-value
p-value
outpatients
1988.706
2933.894
-945.188
-4.235
0.000
inpatients
72.647
96.788
-24.141
-2.642
0.060
total outpatient expenditures each person
106.846
85.437
21.409
2.690
0.011
outpatient drugs expenditures each person
64.541
48.946
15.595
3.968
0.000
3081.089
3236.539
-155.450
-1.380
0.177
1990.841
1976.532
14.310
0.147
0.884
total inpatient expenditures each person
inpatient drugs expenditures each person
Table Ⅱ shows that the outpatients increased 945
per month after the essential drugs are popularized than
before. The total outpatient expenditures for each person
decreased 21.409yuan than non- popularized. In which the
outpatient drugs expenditures decrease 15.595yuan for
each person than non- popularized. The P-values which
are 0.000, 0.011, 0.000 in comparison and contrast test are
less than 0.05. Therefore it can be inferred that the
changes about the data of outpatient after the national
essential medicine system is popularized are significant
comparing with non-popularized. Similarly, the inpatients
increased 24 people while the total inpatient expenditures
for each person increased more 155.450yuan than nonpopularized. Among them, the inpatient drugs
expenditures decreased 14.31yuan for each person. The Pvalues which are 0.06, 0.177, 0.884 in comparison and
contrast test are more than 0.05. Therefore it can be
inferred that the changes about the data of inpatient after
the national essential medicine system is popularized are
not significant comparing with non- popularized.
It can be seen that the township health clinics take on
a phenomenon called “one up and two down” after the
national essential medicine system is popularized by
comparing table Ⅰ with table Ⅱ. In the two sets of data,
outpatient services that are increased by 39.528% and
47.528% have risen dramatically. The outpatient cost for
each person dropped significantly that an average of the
total outpatient expenditure reduced by 28.449yuan and
21.409yuan, a decrease of 26.588% and 20.037%. Among
them, drugs expenditure for each person reduced by
24.449yuan and 15.595yuan, decreased by 37.224% and
24.163%. At the same time, there is a clear decline about
the business income of township health clinics. It can be
seen that the majority of rural residents obtain benefit by
the implementation of essential drugs policy which
canceled the drugs addition, and drugs are cheaper than
before.
Ⅳ. SUGGESTIONS AND COUNTERMEASURES
It is an important measure to deepen the medical and
health system reform for China government to establish
the national essential medicine system. It relates to the
basic rights of everyone to enjoy the health services, to
promote the rational use of drugs, to reform a
phenomenon called “Supporting medicine with drugs” in
medical institutions and ease the medication burden of
patients. The effective measures must be taken to solve
the problems and to ensure the policies to be promoted
continuously during the investigation. To easure people to
“dare to take drugs when they are sick and hospitalize
when they are ill”. The people will no longer worry about
seeing a doctor for medical treatment in rural areas. The
medical staff also generally feel that the primary medical
conditions are improved significantly, the number of
visits who are ill are increasing gradually and the
relationship between physician and patient is more acute
and harmonious [6].
A. Sound compensation mechanism in township health
clinics
It is one of the core contents of the medical reform
with the use of essential drugs to the implementation of
zero sales slips [1] in township health clinics. The income
structure of the township health clinics is so single that
drugs revenue accounts for a large portion of the total
business income up to 60% ~ 70% [7]. Township health
clinics are required to reach the utilization rate of 50% in
2011 which is growing year by year until all use of
essential drugs after the national essential medicine
system is popularized. This leads that the revenue of
township health clinics fall sharply. Therefore, it is
particularly urgent for township health clinics to be
improved the compensate mechanism. Whether the
compensation mechanism is in place as soon as possible
will directly affect the enthusiasm of the medical staff, as
well as enforcing strength on the grass-roots level and
thereby affecting the effectiveness of national essential
medicine system. Therefore, the Government should
assume the responsibility of financial investment and use
the approach of “pre-allocation and post-settlement” on
the basis of careful research and reasonable definition on
revenue and expenditure of basic health care sectors.
Funds is allocated monthly to the grass-roots health care
sectors in time to ensure the effective implementation of
the national essential medicine system and to solute the
medical phenomenon called “Supporting medicine with
drugs” fundamentally.
B. Increase the input of medical equipments in township
health clinics
Great changes in outpatient services in township
health clinics occurred after the implementation of the
national essential medicine system. But the hospital
business has not been accompanied. On one hand, the data
of inpatient has small changes after the pilot and
popularization of the essential drugs. On the other hand,
there are small changes in total inpatient expenditure and
inpatient drugs expenditure for each person. The reason is
that there is inadequate investment in the input of the
medical equipments investment in the township health
clinics. For example, the price of the basic medical
equipments is generally less than 100,000yuan, let alone
more than 500,000yuan. There is a minimal impact of the
implementation of the national essential medicine system
on the inpatient due to lack of medical equipments.
Therefore, it is necessary to increase investment in
medical equipments in township health clinics. This can
ease the overcrowding of large hospitals to a certain
extent.
C. Quantitative examination, further strengthening the
regulatory
Requirement for the township health clinics is that
the proportion that the essential drugs sales revenue
accounted for the revenue of all drugs sales which are
converted should be more than 50%. All drugs sale
revenue must be divided by a coefficient. It is found that
the coefficient is different in different areas. It is 1.5 in
some areas and it is 1.3 in some other areas. It is to say
that the determination of coefficient is of haphazard.
Therefore the health authorities are required to implement
the rigorous quantitative assessment on the township
health clinics under its jurisdiction. Performance appraisal
system about the implementation of national essential
medicine system must be established soundly. It is
ensured that essential drugs are implemented zero sales
slips and reduce the burden of patient medication
effectively through careful implementation of the pricing
policy of essential drugs, strengthen the daily supervision,
and severe punishment on the price violations behaviors.
D. Improvement the publicity of the national medicine
system and focusing on the effect of publicity
As long as the township health staffs and the majority
of rural residents fully understand and accept the national
essential medicine system, this system will play its role
better. However, the research found that the penetration
rate about essential drugs in pilot areas was significantly
higher than non-pilot areas. The rural residents in some
areas know less about the national essential medicine
system and are lack of understanding of the essential
drugs. It is required to improve the publicity methods on
the basis of the present publicity. First, the medication
behavior of the grass-roots medical staffs must be guided
and regulated. The doctors’ medication tends to be
reasonable, scientific and standardizing by strengthening
the primary medical staff training and assessment,
encouraging the supervision of the use behaviors about
essential drugs on primary health care sectors and medical
staffs by using the information system. Secondly, the state
should take a variety of promotional measures to promote
the national essential medicine system. Publicity mainly
concentrated on what essential drugs are, especially on the
advantage of essential drugs and clarification the
misconceptions that essential drugs is equal to the "bad
medicine", essential drugs reimbursement system and so
on. Community level should also improve the publicity
through posters, panels, columns, and community
physicians. At the same time, other forms of activities
such as community cultural activities can be held to
deepen residents understanding about the policy, to
increase public trust in the essential drugs, to understand
the common sense of rational drug use, to guide the
patient, to change the drug habit, and to promote clinical
preferred and the rational use of essential drugs.
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