"Promoting Rational Medicine Use : Role of Insurance Covering OPD"

About the Roundtable:

Rational medicine use refers to patients receiving medicines appropriate to their clinical needs, in clearly legible prescriptions, at the correct dosage, for an appropriate duration, and at the lowest possible cost to the patient or health system. Ensuring rational use of medicines is a critical goal for health systems worldwide and aligns closely with Sustainable Development Goal 3, which aims to ensure healthy lives and promote well-being for all.

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However, irrational medicine use remains a persistent challenge across many healthcare systems. This includes unnecessary polypharmacy, overuse of antibiotics, prescribing expensive branded medicines when lower-cost alternatives exist, and prescriptions that do not align with standard treatment guidelines. These practices not only increase healthcare costs but also contribute to broader public health concerns such as antimicrobial resistance.

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This roundtable aims to bring together key stakeholders to discuss how insurance mechanisms covering outpatient care (OPD) can influence prescribing behaviour and encourage rational, cost-effective, and patient-centred medicine use.

Why this Dialogue matters:

Patients worldwide interact with healthcare systems most frequently through outpatient consultations. On average, individuals have approximately 6.5 consultations per year, the majority of which occur in outpatient settings.

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Medicines represent a major component of healthcare expenditure in many low- and middle-income countries. As countries expand health coverage, insurance mechanisms covering outpatient medicines are becoming increasingly important.

Insurance design—including reimbursement policies, medicine coverage, provider networks, and claim systems—can significantly influence prescribing practices and healthcare spending.

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Yet there remains limited regional dialogue on how insurance systems can be designed to support rational medicine use.

This roundtable aims to address this gap by creating a platform for cross-sector dialogue and knowledge exchange.

Attendees

• Government and policymakers

• Health insurance organizations

• Hospitals and clinicians

• Academia and researchers

• Pharmaceutical sector

• Public health experts