Promoting Rational Use of Medicines: Core Components - WHO Policy Perspectives on Medicines, No. 005, September 2002
(2002; 6 pages) [French] [Spanish] View the PDF document
Table of Contents
View the documentDefinition of rational use of medicines
View the documentThe problem of irrational use
View the documentAssessing the problem of irrational use
View the documentWorking towards rational use of medicines
Close this folderCore policies to promote more rational use of medicines
View the document1. A mandated multi-disciplinary national body to coordinate medicine use policies
View the document2. Clinical guidelines
View the document3. Essential medicines list based on treatments of choice
View the document4. Drugs and therapeutics committees in districts and hospitals
View the document5. Problem-based training in pharmacotherapy in undergraduate curricula
View the document6. Continuing in-service medical education as a licensure requirement
View the document7. Supervision, audit and feedback
View the document8. Independent medicine information
View the document9. Public education about medicines
View the document10. Avoidance of perverse financial incentives
View the document11. Appropriate and enforced regulation
View the document12. Sufficient government expenditure to ensure availability of medicines and staff
View the documentKey documents
View the documentContacts at WHO Headquarters

10. Avoidance of perverse financial incentives

Financial incentives may strongly promote rational or irrational use. Examples include:


• Prescribers who earn money from the sale of medicines (e.g. dispensing doctors), prescribe more medicines, and more expensive medicines, than prescribers who do not; therefore the health system should be organized so that prescribers do not dispense or sell medicines.

• Flat prescription fees, covering all medicines in whatever quantities within one prescription, lead to over-prescription; therefore user charges should be made per medicine, not per prescription.

• Dispensing fees, calculated as a percentage of the cost of the medicines, encourage the sale of more expensive medicines; therefore a flat dispensing fee irrespective of the price of the medicine is preferable. Although it may lead to price increases for cheaper medicines, it lowers the price of higher cost medicines.

• Patients prefer medicines that are free or reimbursed. If only essential medicines are provided free by government or reimbursed through insurance, patients will pressure prescribers to prescribe only essential medicines. If medicines are only reimbursed when the prescription conforms to clinical guidelines, there may be an even stronger pressure on prescribers to prescribe rationally.

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