Background
Health system reform in China
Changing landscape of supply of essential medicines
National Essential Medicines Policy
Procurement and distribution
Research question
Methods
Settings
Test model | Prefecture | Group | County (or district) | No. of primary care institutions | Population (10,000) | % urban population | Per capita annual income (Yuan RMB) | |
---|---|---|---|---|---|---|---|---|
Rural | Urban | |||||||
Medicine-tied Model | ||||||||
Jingmen Municipality | Intervention | Zhongxiang County | 29 | 101.55 | 56% | 16,230 | 27,940 | |
Control | Dongbao District | 7 | 37.27 | 69% | 15,980 | 31,086 | ||
Duodao District | 4 | 30.64 | 85% | 16,420 | 31,086 | |||
Jingshan County | 15 | 62.73 | 55% | 15,829 | 27,892 | |||
Yichang Municipality | Intervention | Dangyang County | 10 | 46.86 | 50% | 17,791 | 29,641 | |
Control | Yiling District | 12 | 52.41 | 65% | 17,149 | 30,757 | ||
Recipient-tied model | ||||||||
Huanggang Municipality | Intervention | Hongan County | 11 | 60.45 | 41% | 9537 | 23,104 | |
Control | Tuanfeng County | 14 | 34.26 | 37% | 10,244 | 22,717 | ||
Recipient-medicine-tied model | ||||||||
Yichang Municipality | Intervention | Yidu County | 11 | 39.00 | 60% | 17,789 | 31,195 | |
Control | Zhijiang County | 11 | 50.15 | 54% | 17,936 | 28,456 |
Interventions
Original distribution model (control)
New arrangements of distribution model
Medicine-tied distributor
Recipient-tied distributor
Recipient-medicine-tied distributor
Distribution Model | Main Procedure | |
---|---|---|
Medicine-tied distributor | Qualified distributors share the task of delivery of medicines, each delivering certain numbers of medicines. Only one distributor is allowed for each type of medicines. | If established contracts between a supplier and the listed distributors exist, they remain valid. Those distributors are eligible to deliver the medicines specified in their contracts. Suppliers can also enter into a new contract with those who do not have an existing contract, for distributing certain types of medicines. |
Recipient-tied distributor | One distributor is selected by a primary care institution (from those nominated by suppliers and selected by local government) to deliver all of its ordered medicines. | Existing contracts remain valid between a supplier and the listed distributors. A supplier has to establish a new contract with the listed distributors if no valid contract exists. |
Recipient-medicine-tied distributor | A supplier nominates two distributors for each of its supplied medicines. The primary care institution chooses one of them as a distributor for the specified type of medicines. | A supplier nominates two distributors (from the panel list of government approved distributors) for each of its medicines; once accepted, the supplier enters into a contract with the distributors for delivering the specified medicine. |
-
Monetary value (¥) of medicines ordered;
-
Monetary value (¥) of medicines delivered;
-
Monetary value (¥) of medicines received;
Statistical analysis
-
Delivery rate (%) = Monetary value (¥) of medicines delivered / Monetary value (¥) of medicines ordered × 100%
-
Received rate (%) = Monetary value (¥) of medicines received and in stock / Monetary value (¥) of medicines ordered × 100%
Results
Delivery rate (%) | Received rate (%) | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Intervention | Control | Intervention | Control | |||||||
Urban | Pre | Post | Pre | Post | Pre | Post | Pre | Post | ||
Medicine-tied model | No. of orders | 65 | 58 | 89 | 80 | 65 | 58 | 89 | 80 | |
Mean | 97.27 | 97.68 | 89.43 | 83.36 | 97.27 | 97.68 | 89.33 | 83.19 | ||
SD | 3.27 | 2.78 | 18.57 | 27.17 | 3.27 | 2.78 | 18.57 | 27.18 | ||
Rural | ||||||||||
Medicine-tied model | No. of orders | 427 | 396 | 429 | 382 | 427 | 396 | 429 | 382 | |
Mean | 88.29 | 84.42 | 83.27 | 87.02 | 88.24 | 84.25 | 83.13 | 86.87 | ||
SD | 15.84 | 21.09 | 23.67 | 20.07 | 15.85 | 21.10 | 23.67 | 20.11 | ||
Recipient-tied model | No. of orders | 143 | 132 | 169 | 156 | 143 | 132 | 169 | 156 | |
Mean | 85.25 | 66.35 | 84.08 | 85.03 | 84.69 | 66.15 | 83.86 | 84.97 | ||
SD | 12.22 | 28.90 | 13.59 | 12.48 | 12.41 | 28.83 | 13.75 | 12.48 | ||
Recipient-medicine-tied model | No. of orders | 130 | 120 | 157 | 132 | 130 | 120 | 157 | 132 | |
Mean | 78.83 | 82.10 | 85.07 | 84.01 | 78.82 | 81.92 | 84.63 | 84.00 | ||
SD | 22.08 | 26.17 | 17.16 | 21.60 | 22.08 | 26.15 | 17.35 | 21.60 |
Variable | Urban | Rural | ||||||
---|---|---|---|---|---|---|---|---|
β |
p
| 95%CI | β |
p
| 95%CI | |||
lower | upper | lower | upper | |||||
Medicine-tied model | ||||||||
Intervention (vs control) | 9.63 | 0.05 | 0.13 | 19.12 | −12.80 | 0.00 | −18.05 | −7.55 |
Time (pre-post) | −7.01 | 0.01 | −11.96 | −2.06 | 2.94 | 0.02 | 0.43 | 5.45 |
Intervention*Time | 6.32 | 0.10 | −1.15 | 13.80 |
−7.78
|
0.00
| −11.25 | −4.31 |
Recipient-tied model | ||||||||
Intervention (vs control) | – | – | – | – | −8.89 | 0.04 | −17.20 | −0.59 |
Time (pre-post) | – | – | – | – | 1.69 | 0.34 | −1.77 | 5.14 |
Intervention*Time | – | – | – | – |
−19.85
|
0.00
| −24.85 | −14.84 |
Recipient-medicine-tied model | ||||||||
Intervention (vs control) | – | – | – | – | −4.27 | 0.35 | −13.18 | 4.64 |
Time (pre-post) | – | – | – | – | −0.76 | 0.75 | −5.41 | 3.90 |
Intervention*Time | – | – | – | – | 3.99 | 0.24 | −2.67 | 10.65 |
Variable | Urban | Rural | ||||||
---|---|---|---|---|---|---|---|---|
β |
p
| 95%CI | β |
p
| 95%CI | |||
lower | upper | lower | upper | |||||
Medicine-tied model | ||||||||
Intervention (vs control) | 9.66 | 0.05 | 0.14 | 19.19 | −13.10 | 0.00 | −18.34 | −7.86 |
Time (pre-post) | −7.08 | 0.01 | −12.02 | −2.13 | 2.93 | 0.02 | 0.42 | 5.43 |
Intervention*Time | 6.40 | 0.09 | −1.06 | 13.86 |
−7.89
|
0.00
| −11.36 | −4.43 |
Recipient-tied model | ||||||||
Intervention (vs control) | – | – | – | – | −9.17 | 0.03 | −17.50 | −0.84 |
Time (pre-post) | – | – | – | – | 1.83 | 0.30 | −1.63 | 5.29 |
Intervention*Time | – | – | – | – |
−19.65
|
0.00
| −24.67 | −14.63 |
Recipient-medicine-tied model | ||||||||
Intervention (vs control) | – | – | – | – | −3.68 | 0.42 | −12.57 | 5.22 |
Time (pre-post) | – | – | – | – | −0.26 | 0.91 | −4.93 | 4.41 |
Intervention*Time | – | – | – | – | 3.37 | 0.32 | −3.31 | 10.05 |