Availability, use, and affordability of medicines in urban China under universal health coverage: an empirical study in Hangzhou and Baoji.
Availability, use, and affordability of medicines in urban China under universal health coverage: an empirical study in Hangzhou and Baoji.
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DOI：
10.1186/s12913-018-2993-1
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发表时间：
2018-03-27
影响因子：
2.8
通讯作者：
Chen W
中科院分区：
文献类型：
--
作者：
Huang Y;Jiang Y;Zhang L;Mao W;van Boven JFM;Postma MJ;Chen W
本研究旨在考察2009年医疗卫生体制改革（包括实施全民健康覆盖）后中国城市的药品可获得性、使用和可负担性。这项纵向研究在杭州（高收入，中国东部）和宝鸡（低收入，中国西部）进行。进行了五次年度家庭调查（2009年至2013年每年一次），以评估全民健康覆盖对药品使用和支出的影响，并在2013年进行了一次卫生设施调查，以评估药品的可获得性。2009年在杭州和宝鸡建立了一个800多户家庭的队列，20家医院被纳入卫生机构调查。使用卫生设施和家庭调查的数据确定药物使用情况。计算了平均两周的自付药品支出，以评估药品的可负担性。杭州市基层医疗机构药品库存量下降，宝鸡市药品库存量上升。在宝鸡，尽管基层医疗机构基本药物的可获得性提高了48.2%，但患者通常选择药店直接购药。大多数调查对象表示，他们的药品需求基本得到满足，但药品费用仍占其卫生支出的主要部分。2009年至2013年，药品支出呈上升趋势。家庭医疗总支出的年均增长率明显高于家庭非食品消费支出的年均增长率。随着中国医疗卫生体制改革和全民健康覆盖的实施，城市地区的药品供应和使用情况有所改善。然而，药品的负担能力仍然是一个令人担忧的问题。本文的在线版本（10.1186/s12913-018-2993-1）包含补充材料，可供授权用户使用。
This study aimed to examine the availability, use, and affordability of medicines in urban China following the 2009 Health Care System Reform that included implementation of universal health coverage (UHC). This longitudinal study was performed in Hangzhou (high income, eastern China) and Baoji (lower income, western China). Five yearly household surveys were conducted (one each year from 2009 to 2013) to evaluate the impact of UHC on medicines use and expenditure, and a health facility survey was conducted in 2013 to evaluate availability of medicines. A cohort of over 800 households in Hangzhou and Baoji was established in 2009, and 20 hospitals were included in the health facility survey. Medicines use was determined using data from health facility and household surveys. An average, two-week out-of-pocket medicines expenditure was calculated to assess the affordability of medicines. The number of medicines stocked in primary health facilities in Hangzhou decreased, while the number in Baoji increased. In Baoji, patients usually chose a pharmacy to buy medicines directly, despite the 48.2% increased availability of essential medicines in primary health care centers. The majority of survey respondents stated that their medicines need was basically met; however, medicines cost still accounted for a major part of their health expenditure. Medicines expenditure showed an increasing trend from 2009 to 2013. The average annual growth rate of household overall medical expenditure was significantly higher than that for household non-food consumption expenditure. Following China’s Health Care System Reform and implementation of UHC, availability and use of medicines has improved in urban areas. However, the affordability of medicines is still a concern. The online version of this article (10.1186/s12913-018-2993-1) contains supplementary material, which is available to authorized users.
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