1、1Practice and Thinking on Promoting the National Basic Drug SystemAbstract. That the establishment of national essential drug system is the reform focus to deepen the medical and health system. This paper introduces the situation of Jinan city ever sine last year， in the process of practice and expl
2、oration in the implementation of essential drug system.We think the effect of the basic drug system implementation is remarkable， but there are still some problems and difficulties existing in financial compensation， in achieving full coverage and in establishing the rural medical and health institu
3、tions.To solve these problems， the key lies in establishing three integrated system of subsidies of the province， the city and the district， so as to improve further the supporting policies. Key words： National Essential Medicine System； Medical Reform； Advance； Practice It is major decision for the
4、 Party Central Committee and the State Council to establish the national essential drug system to secure the basic medication and the health level of 2all the people and it is also one of the recent five reform measures to deepen the medical and health system. Since the starting of the implementatio
5、n of national essential drug system from August 2009， China has made positive progress and achievements and in September 2011， the medical office of the State Council announced in Beijing that Chinas basic drug systems were preliminary built. From looking on the whole， the basic drug systems basic c
6、overage achieved ahead of schedule and the basic drug centralized purchasing has been fully implemented among the provinces. Since March 2010， the city of Jinan started the implementation of national essential drug system， and achieved positive progress and effectiveness .As the result， the masses c
7、ogently got material benefits. However， along with the process and the deepening of reform， some deep-rooted contradictions and problems have been highlighted， so it has important guiding role for us to give careful analysis of the new contradictions and problems and to put forward new ideas and sol
8、utions so as to promote the national essential drug systems and carry out the reform smoothly， ensuring health of five key projects completed. The article will do an analysis of implementing effect， and give the analysis of existing problems according to the situation of 3Jinan to promote the nation
9、al essential drug system reform practice and put forward the corresponding countermeasures. 1. The Effect of Implementation The medical authorities of Jinan is carrying out seriously the requirements formulated by the national and provincial governments， that is “The Informed Opinion on the Implemen
10、tation of National Essential Drug System ”.At the same time， the medical authorities strengthen organization and leadership， improve the working mechanism， and the measures are capable， and we can see overall work is steady and the work goes ahead smoothly. The medical departments are the main contr
11、actor to carry out the medical reform， and under the guidance and support the Provincial Department of public health， they strengthened the organization and leadership， worked carefully， and arranged proper coordinate measures， in order to meet the basic medical needs， and at the same time they look
12、ed on access to basic medical and health services as the goal， and they also regarded the peoples benefit， medical personnel satisfaction and the medical institutions vigor as the starting point. Since March of 2010， the implementation of national essential drug system reform have been carried out a
13、mong the 4governments community health service institutions and the apparent effects are being obtained. As the reform leading group，the branches of the government of city such as the committee of development and reform， finance and personnel ，fulfill their duties， make concerted efforts and they ef
14、fectively ensure the health work goes smoothly and 164community health service organizations had been in the implementation of national essential drug system until the June of 2011 in the city of Jinan .They unified in the province drugs online procurement platform， unified procurement， and got cent
15、ralized distribution of drugs. 1.1. The Drug Costs Decreased. Through the implementation of zero profit sales and the unified online procurement， the expensive cost to the masses initially relieved. Since the implementation of essential drug system， the basic medical and health institutions business
16、 income amounts is 236.83 million yuan， among which the drug income is 118.12 million yuan， accounting for the proportion of business income from before the implementation of the 70.85% down to 49.88%； outpatient service fees are down to 43.6 yuan， falling in 37% than carrying out before； and 73 hun
17、dred persons stay and get treatment in hospital ，the number increased 3.6% ； average 5hospitalization cost948.6 yuan， and the fall is 19% than before； and the cost of the basic drugs fall by an average of 35.3%， As the result the patients can get 9.441 million yuan， allowing interest rates to 32%. F
18、rom the data above， we can see the patients do get the benefits from the reform. 1.2 The Utilization Rate of the Community Health Services Increases. The big hospital are too overcrowding before， while the community medical institutions drew a few patients. Since the national essential drug system c
19、arried out in community health service institutions， through zero profit drug measures， and reducing the population in medication costs， we can change the part of community patients with chronic disease patients flow， and these measures make people more willing to choose the treatment in community h
20、ealth service institution， and the situation changed greatly， when the patients got serious illness ， they will go to the big hospitals， otherwise they will not do so . Since the implementation of essential drug system， the number of patients who come to the community health service institutions to
21、get treatment in Jinan City is 386 thousand persons， 14% increased than last year the corresponding period 1.3 The Community Medical Medicine Is More Standardized. 6The current hospital doctor medication is disturbed by multiple effects and multiple interest temptation， leading to irrational drug us
22、e more serious. We can see the example ， antibiotics， hormones， vitamins and infusion as representatives of the drug abuse phenomenon exists generally. After the medical authorities in Jinan city executed the basic drug system， various medical institutions had adopted national307 basic drugs and pro
23、vince206 supplementary drug catalogue， application of antibiotics and intravenous infusion compared with the same period last year decreased by 14.5% and22.3%， the use of hormone prescription ratio is less than 4%， All of these further regulated medical behavior. 2. The Existing problems The impleme
24、ntation of national essential drug system is a benefit to the livelihood， and it breaks old problems of the peoples medical treatment， and it is also the promotion of the health system reform . So it is not only directly related to the vital interests of the people， but it is also the breakthrough o
25、f the grassroots medical and health institutions and inevitably brought a series of the deep-seated contradictions and problems. 2.1. The Fiscal Pressures to the Authorities of the County 7（ or city） Is Raised Totally. At present in our country large hospitals the drug income is from 50% to 60% to t
26、he total income， the grassroots medical institutions amounted to 80% 85%，and pharmaceutical profit rate is as high as 28%. After the implementation of essential drug system， drug addition is canceled， and the income is greatly reduced. In order to ensure the normal operation of the basic medical ins
27、titutions and medical staff and reasonable treatment are not reduced， the authorities of the county （ city ） has to increase the fiscal expenditure. In 2011，the budget arrangements for all types of medical funds is 116.7 million yuan in 10 counties （ city） area and High-tech Zone in Jinan City and b
28、y the end of July， 9.82 million yuan has been allocated （84% of the total budget）. Overall， the financial pressure were significantly increased in each county （ city） area. In some areas due to the county finance is weak， it is difficult to implement relevant policy. It will take 3 years to meet wit
29、h local business staff salaries flat target， namely the staff only can archive 70% of the total salary in 2011， while in 2012 85%， and until 2013， they may get 100%. Now，the scope of comprehensive reform of 76 direct government organized grassroots medical and health institutions are dissolving the
30、8debt， plus that part of its debt burden， the county （ city） area will aggravate the financial burden. 2.2. The Basic Drug System Has not yet Achieved All the Basic Medical and Health Service Coverage. And different to most parts of the country， the holding bodies of Jinan community health service i
31、nstitutions are diverse. There are different types such as the street hospital，the town hospital， city hospital， district hospital ， provincial public hospital， enterprise hospital， and University and private holding hospital etc. The current implementation of essential drug system only cover the sc
32、ope of villages and towns and city streets which hold regional public hospital. Because civilian battalion organized grassroots medical and health institutions with long-term multi-channel compensation mechanism have not been established， and the provincial hospital， tertiary institutions and the bu
33、siness contractors of the community health service institutions because of bad management system and the lack of policy support， the implementation of essential drug system has not achieved. All of the above the persons who have not implemented the basic drug system in basic medical and health insti
34、tutions accounts for 45% of the total. As the result， in the coverage area the residents have difficulties to enjoy fairly the 9benefits of the system. 2.3. Problems Existing in Part Management System of Township Public Health Centers Should Be Ironed Out. Due to historical reasons， a part of Townsh
35、ip Health Center personnel， administrative， business under the District Peoples hospital management， they are not independent legal person， so the medical authorities have difficulties to ratify， and the individual county township hospital transformation of the community health service center is sti
36、ll under the streets of the office of leadership and management， not the implementation of plan management， financial compensation system is not suitable， affecting the national basic drug system further. 2.4. The Problems of the Village Health Rooms and the Building of Rural Doctors Teams Are Urgen
37、t to be Studied and Solved as the Special Subject. There are 4639 administrative villages all together in Jinan city， the government has planned to construct 2366 standardized village health rooms and train rural medical 8498， and every 1000 people can handle rural medicine2.61. A current compensati
38、on policy is difficult to start a village health room implementation of essential drug system. At present， rural medical income 85%-90% derived from 10drug addition income， each rural medical income mostly from 20，000 yuan to 60，000 yuan， the income gap is large. In accordance with the higher level，
39、 per 1000 population should live with 2rural medicine， but the current compensation policies on rural medical special subsidy is per1000 population with 1rural medicine （ Grant 6000 yuan ）. If the implementation of essential drug system is achieved， each countryside medicine annual income is 23000 y
40、uan， the majority of rural medicine is now income substantially reduced. If in accordance with the actual rural medical8498calculation， each countryside medicine annual income will be only 8812 yuan， their income will reduce by more than half. In the village health execute four cost after combinatio
41、n， general medical fee charged is difficult， so it needs further research for the village health rooms to implement the basic drug system. The majority of rural doctors need pay the rental housing， water， electricity， and other costs， and the endowment insurance and other aspects of the reform with high expectations， but the current policy is difficult to fully meet their expectations. 3. The Countermeasures and the Suggestions The implementation of essential drug system， cancellation of drug addition and implementing zero profit drug sales， cut
