Abstract
Thailand’s 1996 National Essential Drug List (NEDL) was based on the World Health Organization (WHO) minimal drug list concept. However, after Cabinet Resolution in February 1998, copayment for drugs outside the NEDL was enforced to Civil Servant Medical Benefit Scheme (CSMBS) beneficiaries. Pressures from CSMBS copayment triggered the 1996 NEDL revision resulted in a new version of “maximum drug list” 1999 NEDL. Promulgated on January 29, 1999, the current 1999 NEDL consisted of 933 items classified as sub-list A., B., C., D. and E whereby DUE must be introduced for the use of sub-list D.
The objectives of this study were 1) to compare the hospital drug list and cost of drug consumption in fiscal year 1999 broken down by sub-lists of 1996 NEDL compared to 1999 NEDL, 2) to analyze the pharmaceutical and therapeutic committee (PTC) decisions on their hospital drug list revision in 1993, 3) to assess the impact of 1999 NEDL on different types of patients, namely CSMBS, Low income patients, Voluntary Health Card Holders and Social Security Scheme (SSS) beneficiaries. The researchers used two approaches: document research and structured telephone interview.
Thirty-four hospitals (39% of proposed samples) agreed to provide electronic database of the fiscal year 1999 drug list and consumption value. Ninety five from 108 hospitals agreed to provide telephone interviews. Despite the fact of maximum list of 1999 NEDL, Department of Medical Service hospitals (DMS) and non-Ministry of Public Health (non-MOPH) public hospitals dispensed quite high proportion of non-ED drugs. Reclassification of previously 1996 non-ED into sub-lists A., B., C., D. and E. of 1999 NEDL account for 9.9%, 24.2%, 32.4%, 42.5% and 42.2% of total drug consumption in district, provincial, regional, DMS and non-MOPH public hospitals respectively. Cost of drug consumption due to reclassification of 1996 non-ED to 1999 DEDL account for 881.67 million Baht in 34 hospitals, this implies that if there were no 1999 NEDL, there will be savings of 881.67 million Baht to insurance schemes assuming that all ED are reimbursable. Sub-list D. drug consumption in 34 hospitals was 602 million Baht in the fiscal year 1999, 24.2% of total drug consumption in these hospitals. Telephone interview reveals to the reasons for adding some more non-EDs into 1999 NEDL by PTC in 15 hospitals are patients have to take and cheap cost. All these drugs were drugs that used to be considered by 1999 NEDL developing subcommittee. There are some extent discriminating dispensing policy, biased towards CSMBS and against Low Income Scheme beneficiaries, Social Insurance and Voluntary Health Card lied in-between, during the 1999 hospital drug list revisions.
