Evaluating the accessibility of essential medicines in China

To evaluate the accessibility of essential medicines in China through a new system which integrated the structure, process, and effect of the National Essential Medicine Policy (NEMP).

A structural equation model was built to verify the reliability of the evaluation system. This study utilized the Delphi method to obtain the structure and process index data, and used the WHO/HAI standard method for the effect index data to evaluate the NEMP. Six regions were selected for empirical analysis so that suggestions for optimization could be put forward.

The structural equation model consisted of three parts: organization structure, executive process, and effect. The factor loading of the three indicators exceeded 0.5, indicating that this model complied with the preliminary fit criteria. In the organizational structure, rules and regulations and resource investment accounted for a large proportion, indicating that they had a great impact on the effect. As for the executive process, the weight of the seven indicators were similar, and they accounted for a large proportion, indicating that each indicator had a non-negligible impact on the effect. The "p" of all the three hypothesizes was less than .01, especially the "p" of hypothesis 3 was less than .001, indicating that the structure and process of NEMP affected the accessibility of the essential medicines, and three components of the model were positively correlated.

Some errors may exist in achieving appropriate expert selection because of potential researcher bias in the Delphi approach. The results from only six provinces in China may not be generalized nationwide.

The structural indicators and process indicators have a significant impact on outcome indicators, and they also have correlations. That is, the formulation and implementation of the national drug policy and related supporting measures play an important role in improving the accessibility of essential medicines.