Most of the interventions described above apply to the private sector as well. For example, basic training of health workers, drug registration, pricing policies, regulation of pharmaceutical promotion, positive reimbursement lists and public education affect the private sector just as much as the public sector. There are a few interventions that specifically aim at the private sector, and these are briefly described below.
In many countries, unfortunately, most continuing education activities are heavily dependent on the support of pharmaceutical companies, as public funds are usually insufficient. Governments should support efforts by university departments and national professional associations to provide independent continuing education, for example based on the national clinical guidelines. This support could be a financial incentive, or simply making sufficient copies of the national clinical guidelines or other materials available.
Regulatory measures and law enforcement
The government could consider regulatory measures to separate prescribing and dispensing functions, in order to remove a perverse incentive. For example, both dispensing doctors and prescribing pharmacists have a tendency to overprescribe. Generic policies, pricing policies and the dispensing fee structure could be used to encourage the use of essential drugs and promote generic prescribing and substitution. Regulations on the sale of prescription drugs could often be better enforced. In view of the many vested interests, a stepwise approach is recommended.
Drug benefits within health insurance schemes can also have a positive effect on rational prescribing in the private sector. For example, when reimbursement of drug costs is restricted to a positive list and to published clinical guidelines, the patient has a financial incentive to put pressure on the prescriber to stay within the limits of these standards.