Ms C. Krisanaphan, Thailand
The health care delivery system in Thailand comprises both public and private facilities. Public facilities cover 75% of total health care services. The Ministry of Public Health provides approximately 8o% of public health care services, and the Ministry of the Interior, the Ministry of Defence and educational institutions provide the remaining 20%.
The concept of drug selection was first adopted by the Ministry of Public Health in 1973. and a Hospital Formulary was used as a model for selecting drugs in public hospitals within the Ministry of Public Health. The Hospital Formulary was revised regularly and became the “Drug List of the Ministry of Public Health” in 1979. The conceptual principle is similar to the WHO Model List of Essential Drugs.
With WHO’s support, the national essential drug list was introduced in 1981. It has been regularly revised, for more efficient implementation under current health situations. The latest version contains 677 items according to the needs at various levels of the following healthcare services:
List A: Basic drugs needed at all levels (306 items).
List B: Alternative drugs that may be needed for certain kinds of diseases or patients, or for some temporary uses when drugs in List A are not available (79 items).
List C: Drugs prescribed by specialists (133 items).
List D: Restricted drugs prescribed by specialists with drug utilization evaluation systems (155 items).
List E: Drugs used in government sector projects (4 items).
The national essential drug list covers all government health service institutions. To ensure that it will be efficiently compiled, the Government has integrated the list into procurement systems.
Even though there is no pricing policy on essential drugs, a controlling and monitoring scheme - the medium-price system - has been established by the Ministry of Public Health. A medium-price list has been developed by the Medium Price Committee of the Ministry of Public Health since 1986 and has been periodically updated according to the current drug market situation. Reference prices establish the ceiling price of essential drugs for public health institutional procurement. The reference price is the reasonable price which promotes high quality drug procurement. A high reference price results in expensive drugs. A low reference price may result in substandard drugs or shortage of drugs.
During the current economic crisis, there have been special efforts to provide good health services at low cost. One of these efforts involves procurement of high quality drugs at lower prices through the provincial bargaining system. This system increases purchasing power, which brings down drug prices.