OBJECTIVE:To evaluate the effect of the implementation of national essential drug system on rational use of drugs in community health service centers from Shanghai area.METHODS:50 prescriptions had been randomly sampled every month from 6 sampling institutions during last six months of 2010 and 2011.A total of 3 600 prescriptions were collected.6 indicators had been calculated and compared,such as drug cost per prescription,drug types per prescription,amount of drugs per prescription,percentage of antibiotics,percentage of hormone and percentage of injection.RESULTS:The value of 6 indicators decreased after the implementation of national essential drug system;amount of drugs per prescription in urban sampling institutions,drug cost per prescription,amount of drug per prescription,percentage of antibiotics and percentage of injection in rural sampling institutions were all decreased;there were statistical significances(P0.05),compared with before the implementation of the system.CONCLUSION:National essential drug system plays a role in rational use of drugs in community health service centers;the implementation of national essential drug system mainly promote rational drug use of rural community health service centers,because drug use of urban centers is already reasonable before that.

OBJECTIVE:To analyze the changes of the situation of essential drugs supply in community health centers after the implementation of national essential drug system(NEDS) in Shanghai.METHODS:The changes of the quantity and types of essential medicines supplied were compared before and after the implementation of NEDS;the diversity of drugs species supplied by different community health centers was also compared.RESULTS CONCLUSION:After the implementation of NEDS,355 types of essential drugs are provided evenly by the sample institutions,increased by 30 types than before at the same period.The quantity of essential drugs supplied is affected by the total fixed budget of medical insurance in Shanghai and the cancellation of drugs markup rate.After the implementation of NEDS,nitroglycerin and other 20 kinds of western drugs,Baoji pills and other 28 kinds of Chinese patent medicines are additionally provided by the sample institutions;15 kinds of western drugs and 4 kinds of chinese medicines disappear among essential drugs.There are some differences in the types of essential drugs among sample institutions.140 kinds of drugs are provided in every sample institution.166 kinds of drugs are provided in none of sample institution,in which 13 types haven't acquired public bidding and 12 types not tender by pharmaceutical enterprises.

OBJECTIVE:To analyze the effects of the implementation of national essential drug system(NEDS) on grass-roots terminal market of pharmaceutical industrial enterprises in Shanghai.METHODS:The number and the market concentration ratio(CR) of pharmaceutical industrial enterprises in the primary terminal market were compared before and after the implementation of NEDS;the number and the market concentration ratio(CR) of pharmaceutical industrial enterprises in the grass-roots terminal market and non-primary terminal market were compared after the implementation of NEDS.RESULTS CONCLUSION:The implementation of NEDS induces cards-shuffling effect among pharmaceutical industrial enterprises in the grass-roots terminal market;NEDS has showed market crowding-out effect.NEDS promotes the primary terminal market CR of the pharmaceutical industrial enterprises.CR1,CR4 and CR8 have elevated by 6.18%,17.52% and 29.96% respectively in the second half of 2011;large-scale enterprises,large-scale foreign enterprises and non-Shanghai enterprises have the trend of occupying more market share in the primary terminal market.

OBJECTIVE:To evaluate the effects of national essential drug system(NEDS) on financial compensation of community health center in Shanghai.METHODS:The operation situation of community health care center was described before and after the implementation of NEDS;the reasons that caused the changes were analyzed.RESULTS:All of community health care centers had a total profit of 1 billion before the implementation of NEDS,and then had a deficit of 2 billion after the implementation.After the implementation of NEDS,the government input had increased by 8.46 billion,the balance of drug had reduced by 3.19 billion,the balance of medical service had reduced by 7.51 billion,in which the personal expenditure had increased by 5.24 billion.Due to the cancellation of drug markup rate and the escalation of human resources cost,although the government input had increased,it was still hard to cover the medical service deficit.CONCLUSION:The government should have a full consideration of the escalation of medical service cost caused by inflation and rising prices,and raise the price of medical service appropriately.