Implementation effects of the full coverage policy for medicines: a systematic review_Chinese Journal of Evidence-Based Medicine

Authors：

ZHAI Chenchen ¹ , ZHOU Zanrong ² , GUO Zhigang ³ , ZHENG Liguang ³ , LI Wensheng ⁴ , SHI Luwen ^1,4 ,  GUAN Xiaodong ^1,4

1. School of Pharmaceutical Sciences, Peking University, Beijing, 100191, P.R.China;
2. Zhejiang Provincial Center for Occupational Hazards Prevention, Hangzhou, 310007, P.R.China;
3. Department of Pharmacy, Peking University School and Hospital of Stomatology, Beijing, 100081, P.R.China;
4. International Research Center for Medicinal Administration, Peking University, Beijing, 100191, P.R.China;

Corresponding?author：

GUAN Xiaodong, Email: guanxiaodong@bjmu.edu.cn

Keywords：

Essential medicines; Full coverage; Free; Equity; Accessibility; Systematic review

DOI：

10.7507/1672-2531.201808105

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objectives To systematically review the implementation effects of the full coverage policy for medicines, and to provide evidence for the improvement of National Essential Medicine Policy in China.Methods We searched databases including ProQuest, PubMed, CNKI and WanFang Data databases from inception to June 30^th 2018 to collect the studies on full coverage policy for medicines. Two reviewers screened literature and extracted related information independently. Then, qualitative analyses were applied to evaluate the impact of the full coverage policy for medicines.Results A total of 35 studies on the full coverage policy for medicines were included. Ten studies evaluated the effects of disease control, 12 studies evaluated the impact of the compliance of the patients, 9 studies evaluated the impact on medical expenses and drug costs, 2 studies evaluated the effects of equality, 7 studies evaluated economics, and 11 studies described the improper use and waste of medicines.Conclusions In the content of perfecting the selection mechanism and management system, the implementation of the full coverage policy for essential medicines is conducive to promoting equality and accessibility, enhancing drug compliance, improving the diagnosis and treatment of patient diseases ultimately, and making the policy more economical.

Citation： ZHAI Chenchen, ZHOU Zanrong, GUO Zhigang, ZHENG Liguang, LI Wensheng, SHI Luwen, GUAN Xiaodong. Implementation effects of the full coverage policy for medicines: a systematic review. Chinese Journal of Evidence-Based Medicine, 2019, 19(4): 481-489. doi: 10.7507/1672-2531.201808105 Copy

1.	Yang H, Dib HH, Zhu M, et al. Prices, availability and affordability of essential medicines in rural areas of Hubei province, China. Health Policy Plan, 2010, 25(3): 219-229.
2.	管曉東, 信梟雄, 劉洋, 等. 我國基本藥物可獲得性評價實證研究. 中國藥房, 2013, (24): 2216-2219.
3.	Fang Y, Wagner AK, Yang S, et al. Access to affordable medicines after health reform: evidence from two cross-sectional surveys in Shanxi province, Western China. Lancet Glob Health, 2013, 1(4): e227-e237.
4.	管曉東, 王寶敏, 信梟雄, 等. 免費用藥政策對促進中國藥品公平可及的啟示. 中國衛生政策研究, 2015, 8(2): 54-59.
5.	張小娟, 于保榮, 馬吉祥, 等. 山東省農村貧困高血壓患者藥費補償政策的評價研究. 中國初級衛生保健, 2012, 26(5): 9-13.
6.	郭穎燕, 金靈江, 王良友, 等. 臺州市主要慢性病綜合管理的基本做法和成效. 中國農村衛生事業管理, 2015, 35(3): 339-341.
7.	朱裔彥, 張一英, 陶敏亞, 等. 慢性病綜合防治示范點高血壓患者免費給藥效果評價. 健康教育與健康促進, 2011, 6(4): 274-275.
8.	裴婕, 常峰, 路云, 等. 老年人基本藥物全額保障的經驗及啟示. 衛生經濟研究, 2017, (9): 44-47.
9.	尹曦華, 秦大明, 汪勝隆. 加強軍隊醫療包干管理的幾點思考. 人民軍醫, 1998, 41(2): 112.
10.	嚴健, 蔣文榮. 軍隊人員及醫療包干人員醫療改革初探. 華南國防醫學雜志, 2004, 18(1): 42-43.
11.	王燕燕, 李金琴, 李淮涌. 某醫院免費患者住院診療費用與效率分析. 海軍總醫院學報, 2008, 21(4): 219-221.
12.	Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0. Available at: http://handbook-5-1.cochrane.org/.
13.	Wells GA, Shea B, Connell DO, et al. Newcastle-Ottawa Scale (NOS) for assessing the quality of non-randomized studies in meta-analysis. Available at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
14.	Crombie I. Pocket guide to critical appraisal. London: BMJ Publishing Group, 1996.
15.	Husereau D, Drummond M, Petrou S, et al. ISPOR health economic evaluation publication guidelines-CHEERS good reporting practices task force. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) -explanation and elaboration: a report of the ISPOR health economic evaluation publication guidelines good reporting practices task force. Value Health, 2013, 16(2): 231-250.
16.	Hannes K, Lockwood C, Pearson A. A comparative analysis of three online appraisal instruments' ability to assess validity in qualitative research. Qual Health Res, 2010, 20(12): 1736-1743.
17.	Choudhry NK, Avorn J, Glynn RJ, et al. Full coverage for preventive medications after myocardial infarction. N Engl J Med, 2011, 365(22): 2088-2097.
18.	Choudhry NK, Bykov K, Shrank WH, et al. Eliminating medication copayments reduces disparities in cardiovascular care. Health Aff (Millwood), 2014, 33(5): 863-870.
19.	Kulik A, Desai NR, Shrank WH, et al. Full prescription coverage versus usual prescription coverage after coronary artery bypass graft surgery: analysis from the post-myocardial infarction free Rx event and economic evaluation (FREEE) randomized trial. Circulation, 2013, 128(11 Suppl 1): S219-S225.
20.	于保榮, 馬吉祥, 張小娟. 農村高血壓、糖尿病患者實施免費藥物補償的做法及效果研究. 衛生經濟研究, 2010, (9): 31-33.
21.	胥玉萍, 楊海波, 薄艷青, 等. 社區高血壓病人免費給藥管理模式初探. 中國社會醫學雜志, 2013, 30(1): 48-50.
22.	胥玉萍, 周黎峰, 楊海波. 農村合作醫療高血壓免費服藥的成本-效益分析. 臨床薈萃, 2012, 27(5): 393-394.
23.	吳同浩, 秦小燕, 許倩青, 等. 農村社區免費和自費治療原發性高血壓效果對比. 中國校醫, 2014, 28(2): 122-123.
24.	王紅, 李全生, 丁鵬, 等. 遷安市農村社區高血壓藥物干預效果評價. 現代預防醫學, 2016, 43(21): 3910-3914.
25.	Emmerick ICM, Campos MR, Luiza VL, et al. Retrospective interrupted time series examining hypertension and diabetes medicines usage following changes in patient cost sharing in the 'Farmácia Popular' programme in Brazil. BMJ Open, 2017, 7(11): e017308.
26.	Duru OK, Turk N, Ettner SL, et al. Adherence to metformin, statins, and ACE/ARBs within the diabetes health plan (DHP). J Gen Intern Med, 2015, 30(11): 1645-1650.
27.	González López-Valcárcel B, Librero J, García-Sempere A, et al. Effect of cost sharing on adherence to evidence-based medications in patients with acute coronary syndrome. Heart, 2017, 103(14): 1082-1088.
28.	Marsicano EO, Fernandes NS, Colugnati FA, et al. Multilevel correlates of non-adherence in kidney transplant patients benefitting from full cost coverage for immunosuppressives: a cross-sectional study. PLoS One, 2015, 10(11): e0138869.
29.	Yu B, Zhang X, Wang G. Full coverage for hypertension drugs in rural communities in China. Am J Manag Care, 2013, 19(1): e22-e29.
30.	江宗星, 王曉燕, 王平, 等. 免費藥物治療對高血壓患者服藥依從性的影響. 健康教育與健康促進, 2018, 13(1): 75-77.
31.	薄艷青, 陳霄雯, 蔡雨陽. 免費給藥情景下農村社區高血壓患者用藥情況調查. 中國全科醫學, 2014, 17(16): 1910-1912.
32.	Puig-Junoy J, García-Gómez P, Casado-Marín D. Free medicines thanks to retirement: impact of coinsurance exemption on pharmaceutical expenditures and hospitalization offsets in a national health service. Health Econ, 2016, 25(6): 750-767.
33.	Cutrona SL, Woolhandler S, Lasser KE, et al. Free drug samples in the United States: characteristics of pediatric recipients and safety concerns. Pediatrics, 2008, 122(4): 736-742.
34.	Ito K, Elkin E, Blinder V, et al. Cost-effectiveness of full coverage of aromatase inhibitors for medicare beneficiaries with early breast cancer. Cancer, 2013, 119(13): 2494-2502.
35.	Ito K, Avorn J, Shrank WH, et al. Long-term cost-effectiveness of providing full coverage for preventive medications after myocardial infarction. Circ Cardiovasc Qual Outcomes, 2015, 8(3): 252-259.
36.	Choudhry NK, Patrick AR, Antman EM, et al. Cost-effectiveness of providing full drug coverage to increase medication adherence in post-myocardial infarction medicare beneficiaries. Circulation, 2008, 117(10): 1261-1268.
37.	Rosen AB, Hamel MB, Weinstein MC, et al. Cost-effectiveness of full medicare coverage of angiotensin-converting enzyme inhibitors for beneficiaries with diabetes. Ann Intern Med, 2005, 143(2): 89-99.
38.	Dhalla IA, Smith MA, Choudhry NK, et al. Costs and benefits of free medications after myocardial infarction. Healthc Policy, 2009, 5(2): 68-86.
39.	尹曦華. 軍隊醫療包干管理現狀及改進對策. 解放軍醫院管理雜志, 1997, 4(3): 332-333.
40.	楊驊, 陳新年, 孟垂祥. 經濟發達城市軍人免費醫療管理的思考. 解放軍醫院管理雜志, 1997, (2): 181-183.
41.	常雁軍, 李維國, 柴春雨, 等. 免費患者部分常見病種住院費用分析. 第四軍醫大學學報, 2002, 23(S1): 25-27.
42.	Shepherd-Smith A. Free drugs for India's poor. Lancet, 2012, 380(9845): 874.
43.	隋藝, 孫仁峰, 韓魯寧. 軍隊醫療制度改革前后隨軍家屬就醫情況分析. 沈陽部隊醫藥, 2004, 17(5): 350-351.
44.	王松梅, 張勇. 《醫院免費藥品信息管理系統》的開發與應用. 武警醫學, 1997, 8(3): 61-62.
45.	蔡紹麗, 王登高. " 軍字一號”在軍隊免費醫療管理中的運用及意義. 重慶醫學, 2005, 34(6): 838-839.
46.	Robinson JC, Brown TT, Whaley C, et al. Association of reference payment for colonoscopy with consumer choices, insurer spending, and procedural complications. JAMA Intern Med, 2015, 175(11): 1783-1789.
47.	張永慶, 毛記云. " 免費”商業模式的經濟學分析. 商業經濟, 2012, (7): 34-35.
48.	李永強, 史亞莉, 李劍南. 免費經濟學視角下免費顧客網絡價值研究綜述. 經濟學動態, 2012, (8): 88-91.
49.	Guo Z, Guan X, Shi L. The impacts of implementation of National Essential Medicines Policies on primary healthcare institutions: a cross-sectional study in China. BMC Health Serv Res, 2017, 17(1): 723.

1. Yang H, Dib HH, Zhu M, et al. Prices, availability and affordability of essential medicines in rural areas of Hubei province, China. Health Policy Plan, 2010, 25(3): 219-229.
2. 管曉東, 信梟雄, 劉洋, 等. 我國基本藥物可獲得性評價實證研究. 中國藥房, 2013, (24): 2216-2219.
3. Fang Y, Wagner AK, Yang S, et al. Access to affordable medicines after health reform: evidence from two cross-sectional surveys in Shanxi province, Western China. Lancet Glob Health, 2013, 1(4): e227-e237.
4. 管曉東, 王寶敏, 信梟雄, 等. 免費用藥政策對促進中國藥品公平可及的啟示. 中國衛生政策研究, 2015, 8(2): 54-59.
5. 張小娟, 于保榮, 馬吉祥, 等. 山東省農村貧困高血壓患者藥費補償政策的評價研究. 中國初級衛生保健, 2012, 26(5): 9-13.
6. 郭穎燕, 金靈江, 王良友, 等. 臺州市主要慢性病綜合管理的基本做法和成效. 中國農村衛生事業管理, 2015, 35(3): 339-341.
7. 朱裔彥, 張一英, 陶敏亞, 等. 慢性病綜合防治示范點高血壓患者免費給藥效果評價. 健康教育與健康促進, 2011, 6(4): 274-275.
8. 裴婕, 常峰, 路云, 等. 老年人基本藥物全額保障的經驗及啟示. 衛生經濟研究, 2017, (9): 44-47.
9. 尹曦華, 秦大明, 汪勝隆. 加強軍隊醫療包干管理的幾點思考. 人民軍醫, 1998, 41(2): 112.
10. 嚴健, 蔣文榮. 軍隊人員及醫療包干人員醫療改革初探. 華南國防醫學雜志, 2004, 18(1): 42-43.
11. 王燕燕, 李金琴, 李淮涌. 某醫院免費患者住院診療費用與效率分析. 海軍總醫院學報, 2008, 21(4): 219-221.
12. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0. Available at: http://handbook-5-1.cochrane.org/.
13. Wells GA, Shea B, Connell DO, et al. Newcastle-Ottawa Scale (NOS) for assessing the quality of non-randomized studies in meta-analysis. Available at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
14. Crombie I. Pocket guide to critical appraisal. London: BMJ Publishing Group, 1996.
15. Husereau D, Drummond M, Petrou S, et al. ISPOR health economic evaluation publication guidelines-CHEERS good reporting practices task force. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) -explanation and elaboration: a report of the ISPOR health economic evaluation publication guidelines good reporting practices task force. Value Health, 2013, 16(2): 231-250.
16. Hannes K, Lockwood C, Pearson A. A comparative analysis of three online appraisal instruments' ability to assess validity in qualitative research. Qual Health Res, 2010, 20(12): 1736-1743.
17. Choudhry NK, Avorn J, Glynn RJ, et al. Full coverage for preventive medications after myocardial infarction. N Engl J Med, 2011, 365(22): 2088-2097.
18. Choudhry NK, Bykov K, Shrank WH, et al. Eliminating medication copayments reduces disparities in cardiovascular care. Health Aff (Millwood), 2014, 33(5): 863-870.
19. Kulik A, Desai NR, Shrank WH, et al. Full prescription coverage versus usual prescription coverage after coronary artery bypass graft surgery: analysis from the post-myocardial infarction free Rx event and economic evaluation (FREEE) randomized trial. Circulation, 2013, 128(11 Suppl 1): S219-S225.
20. 于保榮, 馬吉祥, 張小娟. 農村高血壓、糖尿病患者實施免費藥物補償的做法及效果研究. 衛生經濟研究, 2010, (9): 31-33.
21. 胥玉萍, 楊海波, 薄艷青, 等. 社區高血壓病人免費給藥管理模式初探. 中國社會醫學雜志, 2013, 30(1): 48-50.
22. 胥玉萍, 周黎峰, 楊海波. 農村合作醫療高血壓免費服藥的成本-效益分析. 臨床薈萃, 2012, 27(5): 393-394.
23. 吳同浩, 秦小燕, 許倩青, 等. 農村社區免費和自費治療原發性高血壓效果對比. 中國校醫, 2014, 28(2): 122-123.
24. 王紅, 李全生, 丁鵬, 等. 遷安市農村社區高血壓藥物干預效果評價. 現代預防醫學, 2016, 43(21): 3910-3914.
25. Emmerick ICM, Campos MR, Luiza VL, et al. Retrospective interrupted time series examining hypertension and diabetes medicines usage following changes in patient cost sharing in the 'Farmácia Popular' programme in Brazil. BMJ Open, 2017, 7(11): e017308.
26. Duru OK, Turk N, Ettner SL, et al. Adherence to metformin, statins, and ACE/ARBs within the diabetes health plan (DHP). J Gen Intern Med, 2015, 30(11): 1645-1650.
27. González López-Valcárcel B, Librero J, García-Sempere A, et al. Effect of cost sharing on adherence to evidence-based medications in patients with acute coronary syndrome. Heart, 2017, 103(14): 1082-1088.
28. Marsicano EO, Fernandes NS, Colugnati FA, et al. Multilevel correlates of non-adherence in kidney transplant patients benefitting from full cost coverage for immunosuppressives: a cross-sectional study. PLoS One, 2015, 10(11): e0138869.
29. Yu B, Zhang X, Wang G. Full coverage for hypertension drugs in rural communities in China. Am J Manag Care, 2013, 19(1): e22-e29.
30. 江宗星, 王曉燕, 王平, 等. 免費藥物治療對高血壓患者服藥依從性的影響. 健康教育與健康促進, 2018, 13(1): 75-77.
31. 薄艷青, 陳霄雯, 蔡雨陽. 免費給藥情景下農村社區高血壓患者用藥情況調查. 中國全科醫學, 2014, 17(16): 1910-1912.
32. Puig-Junoy J, García-Gómez P, Casado-Marín D. Free medicines thanks to retirement: impact of coinsurance exemption on pharmaceutical expenditures and hospitalization offsets in a national health service. Health Econ, 2016, 25(6): 750-767.
33. Cutrona SL, Woolhandler S, Lasser KE, et al. Free drug samples in the United States: characteristics of pediatric recipients and safety concerns. Pediatrics, 2008, 122(4): 736-742.
34. Ito K, Elkin E, Blinder V, et al. Cost-effectiveness of full coverage of aromatase inhibitors for medicare beneficiaries with early breast cancer. Cancer, 2013, 119(13): 2494-2502.
35. Ito K, Avorn J, Shrank WH, et al. Long-term cost-effectiveness of providing full coverage for preventive medications after myocardial infarction. Circ Cardiovasc Qual Outcomes, 2015, 8(3): 252-259.
36. Choudhry NK, Patrick AR, Antman EM, et al. Cost-effectiveness of providing full drug coverage to increase medication adherence in post-myocardial infarction medicare beneficiaries. Circulation, 2008, 117(10): 1261-1268.
37. Rosen AB, Hamel MB, Weinstein MC, et al. Cost-effectiveness of full medicare coverage of angiotensin-converting enzyme inhibitors for beneficiaries with diabetes. Ann Intern Med, 2005, 143(2): 89-99.
38. Dhalla IA, Smith MA, Choudhry NK, et al. Costs and benefits of free medications after myocardial infarction. Healthc Policy, 2009, 5(2): 68-86.
39. 尹曦華. 軍隊醫療包干管理現狀及改進對策. 解放軍醫院管理雜志, 1997, 4(3): 332-333.
40. 楊驊, 陳新年, 孟垂祥. 經濟發達城市軍人免費醫療管理的思考. 解放軍醫院管理雜志, 1997, (2): 181-183.
41. 常雁軍, 李維國, 柴春雨, 等. 免費患者部分常見病種住院費用分析. 第四軍醫大學學報, 2002, 23(S1): 25-27.
42. Shepherd-Smith A. Free drugs for India's poor. Lancet, 2012, 380(9845): 874.
43. 隋藝, 孫仁峰, 韓魯寧. 軍隊醫療制度改革前后隨軍家屬就醫情況分析. 沈陽部隊醫藥, 2004, 17(5): 350-351.
44. 王松梅, 張勇. 《醫院免費藥品信息管理系統》的開發與應用. 武警醫學, 1997, 8(3): 61-62.
45. 蔡紹麗, 王登高. " 軍字一號”在軍隊免費醫療管理中的運用及意義. 重慶醫學, 2005, 34(6): 838-839.
46. Robinson JC, Brown TT, Whaley C, et al. Association of reference payment for colonoscopy with consumer choices, insurer spending, and procedural complications. JAMA Intern Med, 2015, 175(11): 1783-1789.
47. 張永慶, 毛記云. " 免費”商業模式的經濟學分析. 商業經濟, 2012, (7): 34-35.
48. 李永強, 史亞莉, 李劍南. 免費經濟學視角下免費顧客網絡價值研究綜述. 經濟學動態, 2012, (8): 88-91.
49. Guo Z, Guan X, Shi L. The impacts of implementation of National Essential Medicines Policies on primary healthcare institutions: a cross-sectional study in China. BMC Health Serv Res, 2017, 17(1): 723.

Chinese Journal of Evidence-Based Medicine

Implementation effects of the full coverage policy for medicines: a systematic review

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