Making medicines more accessible in China: An empirical study investigating the early progress of essential medicine system

To assess changes in medicine availability and prices as well as subsequent affordability during the early years of the National Essential Medicine System (NEMS) reform in China. Data were obtained from four provinces through a field survey conducted in 2010-2011. Outcome measures were percentage availability, delivery efficiency, ratios of local prices to international reference prices (MPRs), and number of days' household income needed to purchase medicines. Prices were adjusted for inflation/deflation and purchasing power parity. Under NEMS, the median MPR for essential medicines decreased from 3.27 times to 1.59 times from 2009 to 2010. The median medicine expenditure under standard treatments in 2010 equaled 1.06 days household income at a low-income level and 0.25 days household income at a middle-income level. A 25.67% reduction was observed in the average number of medicines stocked by primary healthcare facilities in 2011 compared with 2009 and the availability of essential medicines was 66.83%. During 2009-2011, suppliers could respond to 98.24% of the purchasing orders raised by primary healthcare facilities, and 89.32% of the order amounts could be delivered. The market prices of essential medicines greatly decreased in China after the establishment of NEMS and showed improved affordability in the short term. However, current medicine prices remain high compared to international reference prices. Medicines were often unaffordable for economically backward residents. Future policies still need to target medicine availability as well as affordability.