Table 1 Summary of findings from pre-intervention assessment with patients, village doctors, and medical insurance officials

Medication purchase location

Patients, VDs

The most common place to buy medication is village clinics, followed by DHCs, pharmacies, secondary hospital or above.

Most patients living near urban areas purchase medications in pharmacies due to lower price and more types of medications available.

Most patients living near rural areas purchase medications in village clinics for convenience and lower price for some types of medications.

Unavailability of certain medication types in village clinics. (This actually reflects the low awareness of policy details among patients, since policy applies to all public healthcare institutions, which have a great many type of medications available).

Medication costs

Patients

Hypertensive patients spend 30 to 50 RMB per month on self-medication, which is a low financial burden.

Diabetic patients spend 200 to 300 RMB per month on self-medication, which is a heavy financial burden, and mainly due to the usage of insulin.

Officials

Most patients with diabetes are also diagnosed with hypertension, adding up to the financial burden of self-medication.

Medication compliance

VDs

All interviewed VDs reported cases of medication self-discontinuation, especially among young patients, and attribute the situations to forgetfulness and insufficient awareness of comorbidity threats.

Policy awareness and implementation

Officials

Registration rates in both townships are low. About 12 and 2% of patients recorded in the hospital information system registered in the policy in the two townships, at the time of the interviews.

Poor awareness on the policy details, both among officials of DHCs and village doctors.

Low motivation to promote the policy among village doctors, at primary healthcare facilities.

VDs

Most VDs have heard about the policy, but do not know details and do not know how to register.

Among those VDs who know how to register, they only know patients can register in secondary hospitals and DHCs, but do not know they can help patients register just within village clinics.

Many elderly VDs are not capable of operating the registration system.

Operation systems on computers in some village clinics are outdated, and cannot install and run the registration system.

Village doctors treat low awareness of the policy of the as the primary barrier for policy implementation, followed by complicated registration procedure, negative attitudes toward diseases and medications among some patients, inconvenient to buy medications in designated medical institutions, and low reimbursement rate.

Patients

Majority of patients had never heard of the policy.

Nearly all patients who have registered in the policy are those who visited the DHCs and registered by physicians in these DHCs. Even among these registered patients, some do not know they can enjoy the reimbursements provided by the policy.

Attitudes toward policy

Patients, VDs

Most patients and VDs think the policy can reduce financial burden and enhance medication adherence among patients.

Several patients think the reimbursement rate provided is somewhat low.

VDs

There are some patients heard about the policy from other registered patients and initiatively consult the policy with VDs.

Attitudes toward promoting the policy

VDs

All interviewed VDs would like to promote the policy to patients. The most common reasons for willing to promotion is to reduce financial burden for patients, followed by increasing patients follow-up rate, and requirements from supervisors.

General self-efficacy on policy promotion is high.

Some VDs are cautious toward large-scale promotion for increasing workload.

Officials

Medical insurance staffs at DHCs are cautious toward large-scale policy promotion, since they may become overextended if large-scale registration takes place.