Medicine Prices, Availability and Affordability in Shaanxi Province, Western China. Report of a Survey Conducted from March 26, 2012 to May 4, 2012
(2013; 56 pages)

Abstract

Background: A field study to measure the price, availability, and affordability of selected medicines was undertaken in Shaanxi Province, China, from March 26 to May 4, 2012, using a standardized methodology developed by the World Health Organization and Health Action International.

Methods: The survey of medicine prices and availability was conducted in ten regions: Xian, Yulin, Baoji, Yan’an, Weinan, Xianyang, Shangluo, Ankang, Hanzhong, Tongchuan. Data on 49 medicines (35 of which were on the Essential Medicine List) was collected in 120 public and 120 private sector medicine outlets, selected using a validated sampling frame. Data was also collected on government procurement prices. For each medicine in the survey, data was collected for the originator brand and lowest priced generic equivalent (generic product with the lowest price at each facility). Medicine prices are expressed as ratios relative to Management Sciences for Health international reference prices for 2010 (median price ratio or MPR). Using the salary of the lowest-paid unskilled government worker, affordability was calculated as the number of days' wages this worker would need to purchase standard treatments for common conditions.

Key results: Availability of medicines in the public and private sector: Mean availability of originator brand and generic medicines is the public sector was 7.1% and 20. 0%, respectively, indicating that many patients must purchase medicines in the private sector. In the private sector, the mean availability of originator brand and generic medicines was 12.6% and 29.2%, respectively. Public sector procurement prices: In the public sector, the procurement agency is purchasing medicines at prices higher than international reference prices, indicating a poor level of purchasing efficiency (originator brands and lowest priced generics were 8.89 and 1.49 times higher priced than reference prices respectively)

Public sector patient prices: Overall final patient prices for lowest priced generic medicines in the public sector were 1.69 times their international reference prices and originator brands were 11.83 times higher. Public sector patient prices for generic medicines were 13.4% more than those for public procurement and originator brands were 33% more, indicating higher mark-ups in the public sector distribution chain. Private sector patient prices: Overall final patient prices for originator brands and lowest priced generics in the private sector are about 10.72 and 1.86 times their international reference prices, respectively. When originator brand medicines are prescribed in the private sector, patients pay about 137% more than they would for lowest priced generics. Generic medicines were priced 24.2% higher in the private sector than in the public sector, and originator brands were about 13% lower priced in the private sector.

Affordability of standard treatment regimens: In treating common conditions using standard regiments, the lowest paid unskilled government worker would need between 0.1 (hypertension) and 4.7( hypertension) days’ wages to purchase lowest priced generic medicines from the private sector. If originator brands are prescribed, costs escalate to between 0.7 and 11.5 days' wages, respectively. Some treatments were clearly unaffordable, e.g. the treatment of an ulcer with originator brand omeprazole would cost 11.5 days' wages.

Conclusions: The results of the survey show that the affordability, availability and price of medicines in China should be improved in order to ensure equity in access to basic medical treatments, especially for the poor. This requires multi-faceted interventions, as well as the review and refocusing of policies, regulations and educational interventions.

 
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