Abstract
Use of expensive non-essential drugs is a major driver of rapid growth of health care expenditure,
especially for Civil Servant Medical Benefit Scheme (CSMBS). This study reviews past and ongoing national
policy interventions aiming to promote rational use of drugs (RUD) in public sectors, with respect
to National Lists of Essential Medicines (NLEM) and public insurance schemes. The study employs the
World Health Organization framework on recommended interventions, including (1) national drug policy
body, (2) NLEM, (3) monitoring and auditing system, (4) financial and payment incentives, (5) sufficient
government expenditure to ensure availability of medicines, (6) ethical criteria for drug sales promotion,
(7) clinical practice guidelines based on evidence-based medicines, and (8) the hospital pharmacy and
therapeutic committee. In summary, the NLEM is a basic measure for promoting RUD and assuring sustainable
insurance systems. The Sub-committee on essential drug list development under the national
committee on drug system development has played a unique role in selection of drugs suitable for use in
hospitals. The national agenda should advocate disincentive in the use of drugs outside the NLEM, using
appropriate provider payment mechanism. The CSMBS board should encourage a rapid introduction of
the prospective payment system. During a transition phase, hospitals should be closely monitored and
audited for prescribing patterns. The newly appointed Drug and Medical Management and Reimbursement
Committee should take a leading role in engaging co-operation from the hospitals and in harmonizing
across the three public insurance schemes. Development of the education system in all levels to ensure
rational drug use is urgently required as it has not been committed before.
