Equity Analysis in Accessibility of Chinese National Reimbursement Drug List

OBJECTIVES: Since 2016, the Chinese government has been regularly implementing the National Reimbursement Drug List Negotiation to improve the accessibility and affordability of drugs. However, due to the differences in the economic development and medical resources in different provinces, there may be potential inequity in patients’ access to drugs in National Reimbursement Drug List (NRDL) in different provinces. Our study aims to estimate the equity of drugs allocation in the 2023 NRDL through the WHO/HAI standardized method, Gini coefficient and Thiel index.

METHODS: We utilized Python to collect data on the allocation of drugs in NRDL from the National Medical Insurance Service platform for all 31 provinces across the country. WHO/HAI standardized method, the Gini coefficient and the Thiel index were used to analyze the accessibility and equity of drugs in NRDL, respectively.

RESULTS: Until March 8, 2024, a total of 412,617 pieces of data have been collected, involving 342(94.45%) drugs in 2023 NRDL. The average allocation rate in second-level hospital and third-level hospital is 2.25% and 12.09%, respectively. The maximum difference of allocation rate between different provinces is 11.68%. The Gini coefficients of second-level hospital and third-level hospital are 0.30 and 0.26, respectively. The Thiel index shows that the equity of drugs allocation in second-level hospital is worse in Jilin province and Tibet province. Among the third-level hospital, the equity is worse in Guangxi, Qinghai, Sichuan and Tibet provinces.

CONCLUSIONS: Equity in accessibility of innovative medicines is a key step to promote health equity, and the results of the study show that the accessibility and equity of allocation about the drugs in NRDL vary widely among different provinces. Provinces located in west and northeast tend to have lower accessibility and worse equity. Therefore, it is recommended to fully consider and promote the drug accessibility and equity among provinces when formulating policies.