Availability and equity analysis of China’s National Reimbursement Drug List-negotiated drugs: a national cross-sectional analysis

Ensuring equitable access to innovative drugs is crucial for public health. Despite the inclusion of innovative drugs on China’s National Reimbursement Drug List, disparities in availability persist across regions and healthcare facility levels. This study aims to assess the availability and equity of NRDL-listed innovative drugs in China and analyse regional and institutional disparities. Availability was assessed using the WHO/HAI methodology, whereas equity analysis was conducted using the Gini coefficient and Theil index. We firstly constructed a healthcare resource index S as the core analytical unit for equity evaluation, and adopted a dual-weighting strategy based on population and healthcare facilities to comprehensively measure multidimensional regional drug distribution disparities. This study examined regional variations, hospital-level differences, and intra- and inter-regional disparities in drug availability. The availability of NRDL-listed innovative drugs was low, although tertiary facilities (12.09 ± 12.46)% exhibited significantly higher rates than did secondary facilities (2.25 ± 3.49)%. Regional disparities were evident, as the East region had the highest availability (tertiary: 14.16 ± 13.87%, secondary: 3.13 ± 4.02%), while the West and Northeast regions had lower rates. Among tertiary facilities, Shanghai (20.62 ± 19.24) %, Xinjiang (18.05 ± 16.83) %, and Anhui (17.23 ± 18.90) % exhibited the highest availability, whereas Sichuan (8.94 ± 6.23) %, Hubei (10.12 ± 7.14) %, and Shandong (12.17 ± 10.57) % displayed the lowest. Equity analysis using the Gini coefficient indicated better equity in tertiary facilities (0.1–0.3) than in secondary facilities (0.2–0.4). The Theil index revealed that intraregional disparities contributed significantly to the overall inequity, with the East and West regions experiencing the greatest inequality. This study highlights significant disparities in innovative drug availability across regions and healthcare levels, with secondary facilities in the Western and Northeastern regions facing the greatest challenges. Meanwhile, the results of the Thiel Index show that regional differences are the main cause of inequality. Policy interventions are needed to improve equitable access, including standardized hospital drug admission timelines, increased medical insurance funding, and adjustments in hospital evaluation criteria to support provincial secondary healthcare facilities.