Abstract:
BACKGROUND:Before the new round of healthcare reform in China, primary healthcare providers could obtain a fixed 15 % or greater mark-up of profits by prescribing and selling medicines. There were concerns that this perverse incentive was a key cause of irrational medicine use. China's new Essential Medicines Program (EMP) was launched in 2009 as part of the national health sector reform initiatives. One of its core policies was to eliminate primary care providers' economic incentives to overprescribe or prescribe unnecessarily expensive drugs, which were regarded as consequences of China's traditional financing system for health institutions. OBJECTIVES:The objective of the study was to measure changes in prescribing patterns in primary healthcare facilities after the removal of the economic incentives for physicians to overprescribe as a result of the implementation of the EMP. METHODS:A comparison design was applied to 8,258 prescriptions in 2007 and 8,278 prescriptions in 2010, from 83 primary healthcare facilities nationwide. Indicators were adopted to evaluate medicine utilization, which included overall number of medicines, average number of Western and traditional Chinese medicines, pharmaceutical expenditure per outpatient prescription, and proportion of prescriptions that contained two or more antibiotics. We further assessed the use of medicines (antibiotics, infusion, hormones, and intravenous injection) per disease-specific prescription for hypertension, diabetes, coronary artery heart disease, bronchitis, upper respiratory tract infection, and gastritis. A difference-in-difference analysis was employed to evaluate the net policy effect. RESULTS:Overall changes in indicators were not found to be statistically significant between the 2 years. The results varied for different diseases. The number of Western drugs per outpatient prescription decreased while that of traditional Chinese medicines increased. Overuse of antibiotics remained an extensive problem in the treatment of many diseases, though there was some significant improvement in certain diseases, like diabetes in rural areas. Medicine expenditure per prescription also decreased. CONCLUSIONS:It seems that the removal of a perverse economic incentive alone would not lead to improvement of healthcare providers' prescribing patterns. The rationality of the Essential Medicines List and the lack of payers' and providers' meaningful involvement in the development of the policy possibly contribute to the lack of significant changes in prescribing behaviors. It is suggested that China should adopt more comprehensive policies for healthcare facilities, physicians, patients, and payers, rather than just relying on economic incentives to improve rational use of medicines.
journal_name
Pharmacoeconomicsjournal_title
PharmacoEconomicsauthors
Chen M,Wang L,Chen W,Zhang L,Jiang H,Mao Wdoi
10.1007/s40273-013-0068-zsubject
Has Abstractpub_date
2014-03-01 00:00:00pages
245-55issue
3eissn
1170-7690issn
1179-2027journal_volume
32pub_type
杂志文章abstract:BACKGROUND:Pharmacogenetics offers the potential to improve health outcomes by identifying individuals who are at greater risk of harm from certain medicines. Routine adoption of pharmacogenetic tests requires evidence of their cost effectiveness. OBJECTIVE:The present review aims to systematically review published ec...
journal_title:PharmacoEconomics
pub_type: 杂志文章,评审
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journal_title:PharmacoEconomics
pub_type: 临床试验,杂志文章,随机对照试验
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journal_title:PharmacoEconomics
pub_type: 杂志文章,评审
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journal_title:PharmacoEconomics
pub_type: 杂志文章,评审
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journal_title:PharmacoEconomics
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journal_title:PharmacoEconomics
pub_type: 杂志文章,评审
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更新日期:1996-07-01 00:00:00
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journal_title:PharmacoEconomics
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更新日期:2015-06-01 00:00:00
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pub_type: 杂志文章
doi:10.2165/00019053-200826010-00007
更新日期:2008-01-01 00:00:00
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journal_title:PharmacoEconomics
pub_type: 杂志文章,评审
doi:10.2165/00019053-199915050-00001
更新日期:1999-05-01 00:00:00
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journal_title:PharmacoEconomics
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更新日期:2020-10-01 00:00:00
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journal_title:PharmacoEconomics
pub_type: 杂志文章
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更新日期:1998-06-01 00:00:00
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journal_title:PharmacoEconomics
pub_type: 杂志文章,评审
doi:10.2165/00019053-199712050-00004
更新日期:1997-11-01 00:00:00
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更新日期:2002-01-01 00:00:00
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更新日期:2002-01-01 00:00:00
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pub_type: 杂志文章
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更新日期:1994-01-01 00:00:00
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更新日期:2001-01-01 00:00:00
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更新日期:2001-01-01 00:00:00
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pub_type: 杂志文章,评审
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更新日期:2012-04-01 00:00:00
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更新日期:2017-12-01 00:00:00
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更新日期:2004-01-01 00:00:00
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更新日期:1998-07-01 00:00:00
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journal_title:PharmacoEconomics
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更新日期:2005-01-01 00:00:00
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journal_title:PharmacoEconomics
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更新日期:1996-01-01 00:00:00
abstract::The progressive disability of Parkinson's disease results in substantial burdens for patients, their families and society in terms of increased health resource use, poorer quality of life, caregiver burden, disrupted family relationships, decreases in social and leisure activities, deteriorating emotional well-being, ...
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更新日期:2001-01-01 00:00:00
abstract::Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders, with an estimated prevalence rate in the general population of 10-15% in industrialised countries. Although IBS is not a life-threatening disease, it contributes significantly to a large segment of healthcare resource consu...
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更新日期:2006-01-01 00:00:00