Medication Use

So, we are working on a workshop to train public hospital pharmacists and administrators to conduct drug utilization reviews and interventions to optimize medication appropriateness and outcomes. There are many challenges to implementing change here, especially related to the current policies in place. Incentives for cost-effective outcomes seemingly do not exist. Many drugs are available without (or with) a prescription - including antibiotics, cardiovascular meds, many more. For the private hospitals, medications are not a cost center, but rather they are a revenue center. I am told that physicians in private hospitals receive reimbursement for prescriptions they write (and their patients fill). People I have met that are not employed in the health care system have consistently told me that Thailand is 'overmedicated' - all physician encounters result in prescriptions, even if the patient is only seeking advice or reassurance. All in all, it is a challenge to disentangle and understand the health care system in Thailand. Comments are welcome.