Rational Use of Medications in the United States –Policies and Interventions

The goal of the article is to explore the rational use of medication in the United States (U.S.) and to systematically summarize the evidence about the success or failure of rational medication use in the U.S. First, rational drug use is elucidated and the World Health Organization (WHO) perspective is provided. Based on WHO list of interventions to promote rational use of drugs (directly relevant to national health systems) the paper outlines the real-world, U.S. experience, with rational choice of medications. Interventions to promote the rational use of medication in the U.S. are reviewed and assessed in three categories: educational, managerial, and regulatory. The U.S. health system is heterogeneous and most of the WHO guidelines can be found in at least some of the of many U.S. health care sub-systems. The absence of a national drug policy or essential drug lists, the presence of a few strong stakeholders with committed policy preferences, and the absence of integration of the U.S. health system explain the lack of ubiquitous rational medication use policies and the ineffectiveness of those policies that do exist. The need to further develop and implement rational medication-use policies in the U.S. is evident.