Many elements of the prescribing environment may affect the actual prescriptions issued. This section concentrates on dissociating prescribing from dispensing.

When prescribing and dispensing are linked, as when the same economic unit does both, the commercial interest of the distributor may influence prescribing. These two functions must be dissociated. In many countries prescribers are forbidden to sell drugs. In other countries, especially in Asia, doctors sell drugs and pharmacists prescribe, so that the pharmacies dispense very few doctors’ prescriptions. Excessive and irrational consumption of drugs result from such practices.

In the public health services, direct payment for drugs by patients may lead to conflicts of interest if health service personnel are paid a salary or a bonus directly related to the amount of drugs sold. This arrangement exists in many public health services. There is no conflict of interest if the income of the personnel is not directly linked with the drugs that are dispensed. Any payment-by-users system should avoid such a link. The money for salaries and bonuses may indeed come from the sale of drugs, but salary should be calculated on the basis of other activities such as number of consultations, childbirths attended or admissions to hospital.