Abstract
Over two decades, the expenditure for Civil Servant Medical Benefit Scheme (CSMBS) which employed
the open-ended provider payment methods has a continual double-digit annual growth. In recent
years, the outpatient expenditure outpaced the inpatient one. An analysis of prescriptions and expenditures
of the outpatient drugs of 26 out of 34 large public hospitals under the direct billing system in 2009
revealed that on average 41% of total prescriptions and 67% of expenditure belonged to those not covered
by the current National Lists of Essential Medicines. The highest proportion of the non-essential (NE)
drug prescriptions occurred in university hospitals (45%), whereas the NE proportion in the Ministry of
Public Health hospitals and other ministries was relatively lower (35% and 42%, respectively). However,
the NE share of drug expenditure was similar across the three hospital types (66-68%). The top six therapeutic
classes of drugs, sharing 41% of total drug expenditure, were antilipids, anticancers, antiosteoarthritis
(nonsteroidal anti-inflammatory drugs -NSAID, COX-2 inhibitors and symptomatic slow-acting drugs
for osteoarthritis -SYSADOA), antiosteoporosis, angiotensin converting enzyme inhibitors (ACEI) and
antigiotensin-2 receptor blockers (ARB), and antisecretory/antiulcers (histamine-2 receptor antagonists -
H2RA and proton pump inhibitors -PPI). The NE drugs accounted for 86.4% of the expenditure for antilipids,
87.8% for ACEI-ARB, 93.6% for antiulcers and 97.2% for antiosteoarthritis. With respect to market status,
the single-source products accounted for 92.3, 86.0, 65.0, and 44.0% of the expenditure for antiulcers,
antilipids, ACEI-ARB, and antiosteoarthritis, respectively. A case study of university hospital with relatively
low use of NE drugs revealed that leadership of the hospital administrator and the Pharmacy and
Therapeutic committee is a key to success of cost containment that can counteract threats from market
strategies of drug industry and misunderstanding of prescribers toward the use of the NE drugs. It was
recommended the central administration of CSMBS should give priority to cost-containment policies including
reference pricing systems for drug reimbursement, monitoring and evaluation using prescriberspecific
drug utilization data. In addition, appropriate financial incentive for well-performed hospitals,
capacity building for hospital personnel in data analysis and platforms for knowledge sharing should be
introduced.
