Essential medicines reform in China

What are essential medicines? Are they cheap medicines?

• Essential medicines are selected with due regard to public health relevance, evidence on efficacy and safety, and comparative cost-effectiveness.
• They are intended to be available within the context of functioning health systems at all times in adequate amounts, in the appropriate dosage forms, with assured quality and adequate information, and at a price the individual and the community can afford.
• There is a misperception that essential medicines are “cheap” – rather than the best choice of medicine that is value for money.

Why are essential medicine system implemented? Can they curb rising drug prices and over prescription of medicines?

• Countries implement the essential medicines concept for three main reasons.
• The first reason is access and affordability. Medicines can be one of the largest expenses among poor families and contribute to poverty. In these settings, essential medicines programmes have been used to ensure access among the poor. In economically developed countries, the introduction of new medicines is one of the most important drivers of increasing healthcare costs. Therefore, careful selection is undertaken to identify the most cost-effective medicines for the procurement and reimbursement lists. The purpose is to achieve the best possible health outcomes for the lowest possible costs.
• The second reason is rational use. In all countries of the world – rich or poor –there exists at the same time problems of underuse of cost-effective medicines as well as over-prescription of unnecessary medicines. Patients that do not use the most cost-effective medicines can suffer from additional days of illnesses, and time lost from work or school. In addition, irrational use leads to a waste of money. Paying for unnecessary medicines results in fewer resources for other important commodities or services – such as education, food, and clothing. These problems can be prevented through the use of the essential medicines.
• The third reason is quality and safety. Consumers and patients are unable to judge the quality and safety of the production of medical products. Substandard production can lead to higher rates of morbidity and mortality among patients. Therefore, consumers have to rely on the strength of the systems for regulatory approval and quality assurance for medicines.

What progress has been made since the reform of the essential medicines system in China in 2009?

• No other country has implemented such large-scale changes in the medicines system over such a short time.
• Systems have been put into place to improve the quality of medicines, including both Western and traditional medicines. Essential medicines were selected at central level and in most provinces (municipalities, autonomous regions). All publicly operated primary-level facilities now use essential medicines, which are provided to patients at cost at grassroots facilities. Centralized procurement allows for large volumes to be purchased at lower prices. In addition, all essential medicines are included in the insurance reimbursement lists, and the prices for patients are much lower compared with non-essential medicines.
• Based on monitoring data from the regions, the average price of essential medicines at the grassroots facilities decreased by about 25% between 2008 and mid-2011. Increases in the utilization of essential medicines have occurred. These are remarkable achievements over a very short time.

What are WHO's recommendations on strengthening the implementation of the essential medicines system in China?

• To strengthen the implementation of the essential medicines system in China, it is important that the process of selection is based on the highest quality scientific evidence, evidence-based clinical treatment guidelines, and careful consideration of population health needs.
• Consideration should be given to the development of a comprehensive integrated Essential Medicines List (EML) that covers common conditions from primary to tertiary levels of care and linked to insurance reimbursement lists. A stronger emphasis should be placed on the development of clinical practice guidelines for high usage products. The process of guideline development should be consistent with international standards and conducted by independent scientific agencies to ensure highest quality.
• A standardized process and criteria for provincial procurement and tendering is recommended. The quality and safety of medicines must be assured prior to the evaluation of a commercial bid, and it is recommended to promote objective and measurable quality and safety criteria. Compliance with the revised Good Manufacturing Practice Standards should be a key selection criterion under the evaluation of quality and safety. Equivalent quality and efficacy between generics and originator products should be guaranteed.
• Public knowledge and acceptance of generics, essential medicines, and rational use are critical to the success of the essential medicines reform. Changing the prescribing behaviour of healthcare providers is difficult – but it can be done with concerted efforts.

For more information, please contact:

Helen Yu
Communications Officer, WHO China
Office Tel: +86 10 65327191
Email: yuji@wpro.who.int