Data on the prices and availability of 47 medicines were collected from 50 public and 36 private sector medicine outlets in six regions of Shaanxi Province, Western China from September to October 2010. The study was carried out using World Health Organization (WHO)/Health Action International (HAI) methodology for surveying medicine prices, availability, affordability and price components in low- and middle-income countries. Three previous surveys carried out using the WHO/HAI methodology, in Shandong, Shanghai [1] and Hubei, all revealed an alarming lack of access to affordable essential medicines in both the public and private sectors in China. These three surveys were conducted in eastern and central China from 2004 to 2008, prior to China’s new healthcare reform of 2009, which introduced the National Essential Medicines List (NEML). 

The availability of individual medicines was calculated as the percentage (%) of medicine outlets where the medicine was found. The mean availabilities of originator brands and the lowest priced generics were 8.9% and 26.5% in the public sector, and 18.1% and 43.6% in the private sector, respectively. It was pointed out by the authors that the availability data only refer to the day of data collection at each particular facility and may not reflect average monthly or yearly availability of medicines at individual facilities.

The public sector procured generics and originator brands at median price ratios of 0.75 and 8.49, respectively, while patients paid 0.97 and 10.16. Final patient prices for the lowest priced generics and originator brands in the private sector were about 1.53 and 8.36 times their international retail prices, respectively.

In general, originator brands were less affordable than the lowest priced generic drug equivalents in both the public and private sectors. In the private sector, originator brands cost 390.7% more, on average, than their generic drug equivalents. Generics were priced 17.3% higher in the private sector than the public sector. The lowest paid government worker would need 0.1 day’s wages to purchase the lowest priced generic of high blood-pressure treatment captopril from the private sector, compared to 6.6 days’ wages for the high blood-pressure treatment losartan. For originator brands, the costs rise to 1.2 days’ wages for a salbutamol inhaler to treat asthma and 15.6 days’ wages for gastric reflux treatment omeprazole. 

In Shaanxi Province, low availability was observed for all medicines surveyed, particularly for medicines listed on the NEML in the public and private sectors. Despite the fact that the lowest priced generics were cheaper then originator brands in both the public and private sector, medicines were still found to be often unaffordable for ordinary citizens. The authors therefore concluded that the price, availability and affordability of medicines in China should be improved to ensure equitable access to basic medical treatments, especially for the poor.

Conflict of interest
The authors of the research paper [1] reported no conflicts of interest.

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Reference

1.  Jiang M, Yang S, Yan K, et al. Measuring access to medicines: a survey of prices, availability and affordability in Shaanxi province of China. PLoS One. 2013;8(8):e70836.

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