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Distribution of essential medicines to primary care institutions in Hubei of China: effects of centralized procurement arrangements

BACKGROUND: Poor distribution of essential medicines to primary care institutions has attracted criticism since China adopted provincial centralized regional tendering and procurement systems. This study evaluated the impact of new procurement arrangements that limit the number of distributors at th...

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Autores principales: Yang, Lianping, Huang, Cunrui, Liu, Chaojie
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5686827/
https://www.ncbi.nlm.nih.gov/pubmed/29137645
http://dx.doi.org/10.1186/s12913-017-2720-3
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author Yang, Lianping
Huang, Cunrui
Liu, Chaojie
author_facet Yang, Lianping
Huang, Cunrui
Liu, Chaojie
author_sort Yang, Lianping
collection PubMed
description BACKGROUND: Poor distribution of essential medicines to primary care institutions has attracted criticism since China adopted provincial centralized regional tendering and procurement systems. This study evaluated the impact of new procurement arrangements that limit the number of distributors at the county level in Hubei province, China. METHODS: Procurement ordering and distribution data were collected from four counties that pioneered a new distribution arrangement (commencing September 2012) compared with six counties that continued the existing arrangement over the period from August 2011 to September 2013. The new arrangement allowed primary care institutions and/or suppliers to select a local distributor from a limited panel (from 3 to 5) of government nominated distributors. Difference-in-differences analyses were performed to assess the impact of the new arrangements on delivery and receipt of essential medicines. RESULTS: Overall, the new distribution arrangement has not improved distribution of essential medicines to primary care institutions. On the contrary, we found a 7.78–19.85 percentage point (p < 0.01) decrease in distribution rates to rural primary care institutions. Similar results were demonstrated using the indicator of received rates, with a 7.89–19.65 percentage point (p < 0.01) decrease. CONCLUSIONS: Simply limiting the number of distributors does not offer a solution to the poor performance of delivery of essential medicines for primary care institutions, especially those located in rural areas. Procurement arrangements need to consider the special characteristics of rural facilities. In a county, there are more rural primary care institutions than urban ones. On average, rural primary care institutions demand more and are more geographically dispersed compared to their urban counterparts, which may impose increased distribution costs. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12913-017-2720-3) contains supplementary material, which is available to authorized users.
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spelling pubmed-56868272017-11-21 Distribution of essential medicines to primary care institutions in Hubei of China: effects of centralized procurement arrangements Yang, Lianping Huang, Cunrui Liu, Chaojie BMC Health Serv Res Research Article BACKGROUND: Poor distribution of essential medicines to primary care institutions has attracted criticism since China adopted provincial centralized regional tendering and procurement systems. This study evaluated the impact of new procurement arrangements that limit the number of distributors at the county level in Hubei province, China. METHODS: Procurement ordering and distribution data were collected from four counties that pioneered a new distribution arrangement (commencing September 2012) compared with six counties that continued the existing arrangement over the period from August 2011 to September 2013. The new arrangement allowed primary care institutions and/or suppliers to select a local distributor from a limited panel (from 3 to 5) of government nominated distributors. Difference-in-differences analyses were performed to assess the impact of the new arrangements on delivery and receipt of essential medicines. RESULTS: Overall, the new distribution arrangement has not improved distribution of essential medicines to primary care institutions. On the contrary, we found a 7.78–19.85 percentage point (p < 0.01) decrease in distribution rates to rural primary care institutions. Similar results were demonstrated using the indicator of received rates, with a 7.89–19.65 percentage point (p < 0.01) decrease. CONCLUSIONS: Simply limiting the number of distributors does not offer a solution to the poor performance of delivery of essential medicines for primary care institutions, especially those located in rural areas. Procurement arrangements need to consider the special characteristics of rural facilities. In a county, there are more rural primary care institutions than urban ones. On average, rural primary care institutions demand more and are more geographically dispersed compared to their urban counterparts, which may impose increased distribution costs. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12913-017-2720-3) contains supplementary material, which is available to authorized users. BioMed Central 2017-11-14 /pmc/articles/PMC5686827/ /pubmed/29137645 http://dx.doi.org/10.1186/s12913-017-2720-3 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Yang, Lianping
Huang, Cunrui
Liu, Chaojie
Distribution of essential medicines to primary care institutions in Hubei of China: effects of centralized procurement arrangements
title Distribution of essential medicines to primary care institutions in Hubei of China: effects of centralized procurement arrangements
title_full Distribution of essential medicines to primary care institutions in Hubei of China: effects of centralized procurement arrangements
title_fullStr Distribution of essential medicines to primary care institutions in Hubei of China: effects of centralized procurement arrangements
title_full_unstemmed Distribution of essential medicines to primary care institutions in Hubei of China: effects of centralized procurement arrangements
title_short Distribution of essential medicines to primary care institutions in Hubei of China: effects of centralized procurement arrangements
title_sort distribution of essential medicines to primary care institutions in hubei of china: effects of centralized procurement arrangements
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5686827/
https://www.ncbi.nlm.nih.gov/pubmed/29137645
http://dx.doi.org/10.1186/s12913-017-2720-3
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