Objective To investigate the performance of Essential Medicine List (EML) policy over the past one year in Xintian Township Health Center (XTHC), so as to provide references for the delivery, storage and compensation mechanism of essential medicine for township hospitals. Methods Focus interview combined with a questionnaire was carried out to investigate the supply and usage of EML, the situation of both diagnosis-treatment services and the income-expenditure change before and after EML policy. Results a) It showed that there was an increasing trend with the preparation rate of EML from 62.2% before implementation to 87.3% after, and the proportion of EML income to total medicine expenses increased from 39.3% to 90.6% in XTHC. But problems still existed such as incomplete and old variety of medicine; b) The numbers of outpatient-time and inpatient-time kept growing, while medical cost for both average clinic cost and average hospitalization cost decreased to different extent; c) Although the gross income increased slightly, this center was still running in the red with the limited amount of financial assistance; and d) The proportion of medical care and drug kept decreasing while the proportion of drug cost and examination cost kept increasing. Compared with the situation in 2009, the proportion of examination cost from 2010 to 2011 had increased by 30%, and it still remained at the previous level after EML implementation. Conclusion The implementation of EML does not completely change the predicament of “Make compensation for doctors by selling drugs” in township health center. Owing to the sale policy of zero price difference and the poor performance of compensation for township health centers, XTHC is still running under deficit. Evidence-based medicine selection and research on compensation mechanism for underdeveloped areas are urgently needed.
Objective To understand the current situation of medical service and management in Xintian Central Township Health Center (XtC) through on-the-spot investigation, and to provide references for development of key techniques and products for township health centers in medicine allocation and delivery. Methods The questionnaire and the focus interview were carried out, which included the general information, human resources, medical service and management, as well as the practice of essential medicine list. Results a) The hardware conditions of XtC were not good enough, and the income of Lintao county and Gansu provincial government fell short of their needs; b) The General Practitioner (GP)/nurse ratio was higher than that of the national level, the GP/pharmacist ratio was a little bit lower, and the GP/laboratorian ratio reached the national level. There was only one medical technician. There was about 27.5% staff members having no college degree, and about 81% having at most primary profession titles. There were 26 medical workers allocated to XtC in recent two years and only one GP left; c) In 2009, the bed utilization ratio was a little bit higher than the national level (109% vs. 60.7%), while the average length of stay was longer than the national level (6 vs. 4.8); d) The outpatient service in 2010 increased by 17.6% compared to 2009 and the inpatient service in 2010 decreased by 17%; e) The average medical expense per outpatient and per inpatient increased by 23.5% and 14.9%, respectively, in 2010 compared to 2009; f) The essential medicine list (EML) was put into practice in June, 2010. The current count of medicine in hospital was 767, far beyond the EML demand. Conclusion XtC, as a basic rural Township Health Center in Western China, overtakes the burden of healthcare service for local population. The policy of “selecting graduates to work in Township Health Center” made by Gansu government ensures sufficient personnel reserve for rural Township Health Center. XtC needs to cope with challenges of insufficient hardware conditions, unreasonable personnel structure, low educational background and profession title of the staff, and low technical level of medical service. XtC has a big ratio of medicine income and the expense of outpatient is lower than that of the national level. The management of XtC may be influenced by zero-profit price of the essential medicine, and appropriate subsidy and policy support are needed to maintain its service quality. And it is necessary to carry out evidence-based selection of the essential medicine account and develop staff training and essential medicine usage guidance, so as to support the medicine used safely and rationally.