Drug Prescribing in Rural Health Facilities in China: Implications for Service Quality and Cost

Overuse of drugs in rural areas of China has led to a growing concern regarding service quality and cost. The study found evidence of high levels of drug use in some rural health facilities in comparison with a number of other developing countries. Such a result was significantly associated with the government policy of financing health care, regulation and monitoring of health services, and users' attitudes and behaviour. It underlines the need for measures to be taken in China to improve drug use in order to allow its population access to effective care at reasonable cost.Excessive and inappropriate drug prescribing practices in developing countries expose patients to health risks and raise health costs. In China, the transition to a market-oriented economy has been accompanied by a largely unregulated market for drugs and drug sales represent a major source of income for rural health services. This study examined drug prescribing patterns in 3 poor rural counties in China: Donglan (Guangxi province), Shibing (Guizhou province), and Xunyi (Shaanxi province). For each month in 1993, 100 outpatient records were randomly selected from each county hospital and 50 from each health center for review. A total of 7182 prescriptions (generally for 2-3 drugs) were issued. Between one-third and one-half of all prescriptions were for antibiotics. County health bureaus do not monitor the performance of health workers in relation to drugs unless a medical accident occurs. The income of health workers is directly related to the volume of drugs they sell--a factor that, along with patient equation of drug treatment with effective care, reinforces rampant overprescription. The average cost per prescription in township health centers was equal to 5.6, 2.2, and 6.2 times the average per capita daily income in Donglan, Shibing, and Xunyi, respectively. The mark up at health facility pharmacies was 15% for Western drugs and 20% for Chinese drugs and herbs. These findings indicate an urgent need for policies to end financial incentives for health workers to prescribe drugs, limit the right to prescribe or sell drugs to those with well-defined medical training, and ensure access to effective care at a reasonable cost.