User fees and the cost of irrational prescribing

Abstract

Lack of funds, insufficient drug availability and irrational prescribing undermine primary health care in Nepal. This study measured the cost of irrational prescribing and the impact of different kinds of user fee on the cost of irrational prescribing. The study took place within cost-sharing drug re-supply schemes (CSDS) in rural hilly E. Nepal, where the drug supply is supplemented and a nominal user fee charged. A before-after non-randomized controlled trial was conducted. The cost per prescription, the cost of irrational prescribing (wastage) per prescription and % drug cost recovery were measured. It was found that more than one-third the value of all drugs dispensed to patients had been irrationally prescribed and that item fees were associated with 20% financial savings due to reduced irrational prescribing as compared to flat fees. If all irrational prescribing were eliminated it maybe that an amount of drugs equivalent to value of the annual HMG drug indent would last the year round in many health facilities.