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Similar to our findings, a study from 2007 reported that only 61-68% of medicines orders from hospitals and 67% of those from primary health care facilities were fulfilled [ 20].
Health system stewards could also consider carrying out an external assessment of the medicines quantification, procurement and supply system to identify and address barriers, potentially considering moving towards a system which did not rely entirely on health workers placing medicines orders in on time.
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The Kurdish officials I met in Europe complained bitterly about the quality of the food and medicines ordered by Baghdad; a government that once had only the best from Europe and the US can now only afford rancid cooking oil from Egypt and Syrian antibiotics.
DooMedicines
At the time of writing, Canada remains the only country to have successfully exported medicines under the WTO Paragraph 6 mechanism and the HIV/AIDS medicines order to Rwanda remains the only instance where CAMR has been used.
The first dealt with shortcomings of the policy implementation process related to management tools, drug stocks, co-existence of the fee exemption and cost recovery systems, and, above all, supply management for medicines (ordering from private companies, issuing makeshift prescriptions).
Also, the authors said, some doctors practiced "defensive medicine," ordering tests to guard against malpractice lawsuits.
Fears of malpractice lawsuits prompt many doctors to practice "defensive medicine," ordering more tests and procedures than they otherwise would.
Fearful that each subsequent malpractice claim could force them into involuntary retirement, physicians will practice "defensive medicine," ordering unnecessary tests and studies simply to insulate themselves from lawsuits.
At the same time, doctors complain that "defensive medicine" — ordering tests and procedures out of fear of being sued — drives up health costs.
McAllen is a "judicial hellhole" and doctors are practicing defensive medicine, ordering unnecessary tests to protect themselves against lawsuits, and that is driving the difference.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com