World Bank2017-08-102017-08-102010-06https://hdl.handle.net/10986/27722Compared with developed economies, health expenditure in China is not particularly high on a per capita basis or as a share of Gross Domestic Product (GDP). Similarly, pharmaceutical expenditure in comparative perspective is not particularly high on a per capita basis or as a percentage of GDP. China's exceptionally high rate of pharmaceutical expenditure has important implications for the future of a health care system that not only serves a rapidly aging population, but encourages overuse of drugs in ways that are both financially and medically inefficient. Pharmaceutical reform is therefore a high priority for China's health policymakers. Several factors are discussed for reforming this system based on lessons from recent reforms. The section following this introduction briefly reviews the expansion of basic medical insurance coverage in the 2000s and several structural features of the pharmaceutical sector in China. The related concepts of an essential medicines policy, an essential drug list, and a generic drug policy are briefly described in first section. The second section of the paper looks at several hurdles that are built into the path of essential medicines reform. The third section considers some lessons for pharmaceutical reform based on China's recent learning from regional experimentation and piloting initiatives. The fourth section considers several relevant lessons derived from reform experiences in other countries. The fifth section looks at the path forward-success factors for implementing an essential medicines program based on low-cost generic drugs.en-USCC BY 3.0 IGOACCESS TO HEALTH CAREACCESS TO INFORMATIONACTIVE INGREDIENTSAGINGANTIBIOTICSBENCHMARKSBIDDINGBIOEQUIVALENCECANCERCAPACITY BUILDINGCAPITATIONCAPITATION BASISCENTER FOR HEALTHCERTIFICATIONCHRONIC CONDITIONSCHRONIC DISEASESCITIZENCITIZENSCLINICAL GUIDELINESCLINICAL PRACTICECOMMUNITY HEALTHCONSUMER EDUCATIONCOOPERATIVE MEDICAL INSURANCEDECISION MAKINGDEVELOPING COUNTRIESDIABETESDIAGNOSISDIFFERENTIAL PRICINGDISSEMINATIONDISTRIBUTION SYSTEMSDOCTORSDOSAGESDRUG ADMINISTRATIONDRUG INDUSTRYDRUG LISTDRUG MARKETSDRUG POLICIESDRUG PRICESDRUG UTILIZATIONDRUGSECONOMIC IMPLICATIONSECONOMIC PROGRESSEQUAL ACCESSEQUITABLE ACCESSESSENTIAL DRUGSESSENTIAL MEDICINESFAMILIESFEES FOR SERVICESFINANCIAL COMMITMENTFORECASTSFRAUDGENERIC DRUGSGMPGOOD MANUFACTURING PRACTICESGOVERNMENT AGENCIESGROSS DOMESTIC PRODUCTHEALTH AUTHORITIESHEALTH CAREHEALTH CARE COVERAGEHEALTH CARE SYSTEMHEALTH CENTERSHEALTH COVERAGEHEALTH ECONOMICSHEALTH EXPENDITUREHEALTH EXPENDITURESHEALTH FACILITIESHEALTH IMPACTHEALTH INSTITUTIONSHEALTH INSURANCEHEALTH MAINTENANCE ORGANIZATIONSHEALTH OUTCOMESHEALTH POLICYHEALTH PROFESSIONALSHEALTH PROVIDERSHEALTH REFORMHEALTH REFORMSHEALTH RISKSHEALTH SECTORHEALTH SECTOR REFORMHEALTH SERVICEHEALTH SERVICESHEALTH STATUSHEALTH STRATEGIESHEALTH SYSTEMHEALTHCAREHEPATITIS BHIV/AIDSHOSPITALHOSPITAL PHARMACIESHOSPITALSHUMAN RESOURCESHYPERTENSIONILLNESSESINCOMEINFECTIOUS DISEASESINSURANCE COVERAGEINSURANCE SCHEMESINSURERSINTERFERONINTERMEDIARIESINTERVENTIONIRRATIONAL USELACK OF INFORMATIONLARGE NUMBERS OF PEOPLELARGE POPULATIONSLIVING STANDARDSMANAGEMENT SYSTEMSMARKETINGMEDICAL CAREMEDICAL CONDITIONSMEDICAL EDUCATIONMEDICAL INSURANCEMEDICAL SERVICESMEDICAL STAFFMEDICAL SYSTEMSMEDICAL TECHNOLOGIESMEDICATIONMEDICINEMEDICINESMIGRANTMINISTRY OF HEALTHMORTALITYNATIONAL DEVELOPMENTNATIONAL DRUGNATIONAL HEALTH SYSTEMNATIONAL LEVELNATIONAL LEVELSNDPNURSESNUTRITIONPACKAGINGPATIENTPATIENT EDUCATIONPATIENTSPERSONAL RELATIONSHIPSPHARMACEUTICALPHARMACEUTICAL DISTRIBUTIONPHARMACEUTICAL EXPENDITUREPHARMACEUTICAL INDUSTRYPHARMACEUTICAL MANUFACTURERSPHARMACEUTICAL POLICYPHARMACEUTICAL PRICESPHARMACEUTICAL REFORMPHARMACEUTICAL SECTORPHARMACEUTICAL SUPPLIERSPHARMACEUTICAL SUPPLYPHARMACEUTICALSPHARMACISTSPHARMACYPHYSICIANPHYSICIANSPOOLED PROCUREMENTPOOR FAMILIESPRESCRIPTIONSPRIMARY CAREPRIVATE HEALTH INSURANCEPROGRESSPROVIDER PAYMENTPUBLIC EDUCATIONPUBLIC HEALTHPUBLIC HEALTH INSURANCEPUBLIC HOSPITALSPURCHASINGPURCHASING POWERQUALITY ASSURANCEQUALITY OF CAREQUALITY OF SERVICESRATES OF GROWTHRATIONAL DRUG USERATIONAL USE OF DRUGSREFORM EFFORTREGULATORY AUTHORITIESREMEDIESRESPECTRETAIL PHARMACIESRURAL AREASRURAL POPULATIONRURAL RESIDENTSSERVICE CONTRACTSSERVICE PROVIDERSERVICE PROVIDERSSOCIAL HEALTH INSURANCESOCIAL SECURITYSOCIAL WELFARESTATE PLANNINGTHERAPIESTRADITIONAL MEDICINESTREATMENT GUIDELINESTREATMENTSURBAN AREASURBAN ENVIRONMENTSURBAN POPULATIONSUSER FEESWASTEWORKERSWORLD HEALTH ORGANIZATIONPolicy NoteWorld Bank10.1596/27722