The Public Health Ministry argues that the standardisation of drug prescriptions based on a list of essential drugs will not only reduce healthcare costs and ensure fairness to recipients of the different healthcare services but also improve the performance of health service providers, and therefore benefit society as a whole. This proposal is long overdue. The national list of essential drugs, based on guidelines from the World Health Organisation, serves as a model for the selection of drugs on the basis of comparative efficacy and safety, quality and cost consideration. According to the WHO, essential drugs are those that satisfy the healthcare needs of the majority of the population.

The three major healthcare-service providers generally already adhere to the national list of essential drugs. But government hospitals make an exception when they treat patients covered by the CSMBS, which pays for civil servants' medical bills. The reason for this is based on the assumption that government officials should enjoy "better" medical services to compensate for the significantly lower salary they draw compared to those holding comparable jobs in the private sector.

This preferential treatment means that doctors in public hospitals tend to prescribe expensive imported drugs - which are generally understood to be better than the mostly-generic drugs produced locally - when they treat government officials and their relatives covered by the CSMBS. Public hospitals also have no incentive to keep costs under control when they deal with patients covered by CSMBS because they can charge the government under the fee-for-service arrangement.

That explains why the CSMBS and taxpayers have suffered an escalation of costs amounting to billions of baht, which could have been saved. This problem attracted little attention from the government until the 1997 financial crisis. Some cost-saving measures have been introduced, such as excluding very expensive imported drugs for which there are locally produced substitutes, and restrictions on the use of unnecessary healthcare services. But the government still has much room for improvement when it comes to the CSMBS.

Contrast this to the Social Security health insurance and the government's universal healthcare scheme, which are required to strictly adhere to the national list of essential drugs. The Social Security health-insurance service is based on a cost-effective system, under which healthcare providers are paid a yearly sum for each person covered. Under this model, healthcare providers have a strong incentive to control costs because they need to balance their own books against lump-sum payment from the SSO. The government's universal healthcare scheme followed a similar system.

It is disappointing to hear the Food and Drug Administration (FDA), which operates under the Public Health Ministry, voice reservations about the CSMBS falling into line in regard to the adoption of the national list of essential drugs. The notion that government officials get a raw deal in terms of monetary compensation compared to private-sector workers holding comparable jobs is not based on solid, verifiable evidence. Unless and until all benefits enjoyed by state workers - monetary or otherwise - are quantified in baht terms, no rational discussion on how to improve the lot of government officials is possible.

For example, little has been mentioned concerning the fact that CSMBS coverage provides free medical service to an employee's parents, spouse and children under 20 years of age. Or the fact that the rate of admission and the use of costly diagnostic procedures covered by CSMBS continue to be much higher than under other healthcare schemes, which raise the suspicion of an unnecessary or wasteful use of healthcare resources. No one says that government officials do not deserve help from the government to improve their employment conditions and benefits, but social equity in terms of access to cost-effective quality health services must take priority.