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Essential drugs policy in three rural counties in China: What does a complexity lens add?

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  • Xiao, Yue
  • Zhao, Kun
  • Bishai, David M.
  • Peters, David H.

Abstract

In 2009 the government of China identified an essential drugs policy as one of five priority areas for health system reform. Since then, a national essential drugs policy has been defined, along with plans to implement it. As a large scale social intervention, the policy will have a significant impact on various local health actors. This paper uses the lens of complex adaptive systems to examine how the policy has been implemented in three rural Chinese counties. Using material gathered from interviews with key actors in county health bureaus and township health centers, we illustrate how a single policy can lead to multiple unanticipated outcomes. The complexity lens applied to the material gathered in interviews helps to identify relevant actors, their different relationships and policy responses and a new framework to better understand heterogeneous pathways and outcomes. Decision-makers and policy implementers are advised to embrace the complex and dynamic realities of policy implementation. This involves developing mechanisms to monitor different behaviors of key actors as well as the intended outcomes and unintended consequences of the policy.

Suggested Citation

  • Xiao, Yue & Zhao, Kun & Bishai, David M. & Peters, David H., 2013. "Essential drugs policy in three rural counties in China: What does a complexity lens add?," Social Science & Medicine, Elsevier, vol. 93(C), pages 220-228.
    • Handle: RePEc:eee:socmed:v:93:y:2013:i:c:p:220-228
    DOI: 10.1016/j.socscimed.2012.09.034
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    References listed on IDEAS

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    1. Lessard, Chantale, 2007. "Complexity and reflexivity: Two important issues for economic evaluation in health care," Social Science & Medicine, Elsevier, vol. 64(8), pages 1754-1765, April.
    2. Haggis, Tamsin, 2010. "Approaching complexity: A commentary on Keshavarz, Nutbeam, Rowling and Khavarpour," Social Science & Medicine, Elsevier, vol. 70(10), pages 1475-1477, May.
    3. Gatrell, Anthony C., 2005. "Complexity theory and geographies of health: a critical assessment," Social Science & Medicine, Elsevier, vol. 60(12), pages 2661-2671, June.
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    Cited by:

    1. Si, Yafei & Bateman, Hazel & Chen, Shu & Hanewald, Katja & Li, Bingqin & Su, Min & Zhou, Zhongliang, 2023. "Quantifying the financial impact of overuse in primary care in China: A standardised patient study," Social Science & Medicine, Elsevier, vol. 320(C).
    2. Laurène PETITFOUR & Xiezhe HUANGFU & Martine AUDIBERT & Jacky MATHONNAT, 2017. "Efficiency of township hospitals in China in the context of the drug policy reform: Progress should not get bogged in midstream - A case study from a survey in Weifang prefecture," Working Papers P185, FERDI.
    3. Laurène PETITFOUR & Xiezhe HUANGFU & Martine AUDIBERT & Jacky MATHONNAT, 2017. "Efficiency of township hospitals in China in the context of the drug policy reform: Progress should not get bogged in midstream - A case study from a survey in Weifang prefecture," Working Papers P185, FERDI.

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