Patients who wish to purchase prescription drugs from a pharmacy will still have to visit the doctor first to get the prescription, before going to the pharmacy to fill it, thus incurring higher travel and time costs. — Filepic
The number of occasions that I have read Bank Negara Malaysia’s (BNM’s) annual report can be counted on the fingers of one hand.
But when BNM’s 2024 annual report was released, I not only read it, but was flabbergasted by the recommendations to address medical inflation with: “The first strategic thrust is to facilitate greater price transparency.
“Initiatives under this pillar include the display of retail prices for drugs and the publication of price ranges for common healthcare services.
“This publication enables policyholders and ITOs [insurance and takaful operators] to compare prices across different medical providers while promoting healthy competition.”
There is no further elaboration in the report on how drug prices display by private clinics and hospitals will address the issue of increasing healthcare costs.
The truth be told: Very few countries have managed to reduce healthcare costs without compromising safety and quality.
It will be even more difficult in Malaysia where the total healthcare expenditure is less than that of similar middle- income countries, the demographics are changing, and the incidence of the unhealthy is high.
This column addresses the misperception that drug prices display will lower healthcare costs.
Clinic vs pharmacy
There is a vast difference between the dispensing practices of doctors and pharmacists.
When a patient consults a doctor, a provisional diagnosis is made after history-taking and a physical examination, following which investigations may be carried out.
The laboratory, imaging or procedural investigations confirm, or otherwise, the diagnosis made.
Treatment is then prescribed – this may be drugs, procedure(s) or other intervention(s) appropriate for the individual patient’s condition.
The patient has the option of getting any drugs dispensed from the private clinic, hospital or pharmacy.
In the case of the latter, the doctor writes a prescription for the patient.
The doctor is accountable for the prescription made and can be subject to a complaint to the Malaysian Medical Council (MMC), or even litigation, particularly when an adverse event occurs, e.g. when a drug is knowingly prescribed to a patient who is allergic to it.
Drug side effects and interactions are a major issue in medical practice.
A common situation is the increased risk of gastrointestinal adverse events in those taking non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, naproxen and diclofenac, which act as analgesics.
Many patients are unaware that even over-the-counter (OTC) painkillers (analgesics) can cause potentially serious adverse effects, especially when combined with other common drugs like anti-hypertensive (high blood pressure) drugs, corticosteroids or anti-coagulants (blood thinners).
On the other hand, the pharmacist does not diagnose or institute investigations.
(S)he dispenses OTC drugs or drugs prescribed by a doctor, whose bona fide status can be verified on the MMC’s website.
Not as simple as shopping
It appears that there is a misperception that drugs can be purchased from private clinics or hospitals like in sundry shops/supermarkets.
A screenshot of the Health Ministry's Malaysia Medicine Price Guide, which was last updated in August 2024. — Dr MILTON LUM
Anyone can make purchases from sundry shops/supermarkets.
The prices of some items are displayed in accordance with the Price Control and Anti-Profiteering Act 2011.
If one wants to compare prices, one can go to another sundry shop/supermarket.
Try doing that in any private clinic or hospital.
No one can purchase drugs from a private clinic or hospital, not even if one has a prescription from another healthcare facility.
The private clinic or hospital will, in accordance with professional practice, only dispense drugs when prescribed by its own doctor(s).
Therefore, if a patient decides to obtain the drugs from another private clinic or hospital, the patient has to consult another doctor(s) from that private clinic or hospital, incurring additional costs.
If a patient wants to purchase drugs from a retail pharmacy with a doctor’s prescription, there are additional costs of transport and time.
According to the Frequently Asked Questions (FAQs) list distributed at the Health Ministry’s town hall on Feb 27 (2025), drug prices can be displayed in a detailed format in a catalogue, notice board, laptop/personal computer/tablet, or television kiosk/electronic screen.
Private clinics and hospitals do not receive subsidies or tax benefits.
As such, the capital and administrative expenditures for such a display will likely be passed on to the patients.
The Health Ministry and the Malaysia Competition Commission have confirmed that private clinics and hospitals can charge for regulatory compliance(s).
In short, mandatory drug prices display will inevitably increase healthcare costs.
Patients’ rights
Patients’ rights are provided for in the regulations of the Private Health Care Facilities and Services Act.
This act states that patients have a right to information about the “estimated charges for services based upon an average patient with a diagnosis similar to the tentative or preliminary diagnosis of the patient; and of other unanticipated charges for services that is routine, usual and customary”.
Patients also have a right to an itemised bill.
ALSO READ: Our rights as patients to be safe
The exercise of these rights is dependent on patients’ health literacy.
According to the World Health Organization (WHO), it is “personal knowledge and competencies that enable people to access, understand, appraise, and use information and services in ways that promote and maintain good health and well-being for themselves and those around them”.
There are few studies of Malaysians’ health literacy.
In a study conducted as part of the 2019 National Health and Morbidity Survey (NHMS), health literacy was “categorised at a lower sufficiency level”.
It was found that: “Limited health literacy groups were prevalent among respondents with older age (68%), lower education level (64.8%), and lower household income (49.5%).”
For example, there is limited knowledge about diabetes and hypertension, which occur in one in five and three in 10 Malaysians respectively.
A review of Malaysian studies on diabetes knowledge, published April 2024 in the journal Malaysian Family Physician, found “a suboptimal knowledge level among adults with and without diabetes mellitus”.
Meanwhile, a November 2022 study in the same journal found that the frequency of drug non-adherence in uncontrolled hypertension in a primary care setting in Sarawak was 39.3%.
Food for thought
Drug prices displayed in the Health Ministry’s website was last updated on Aug 29, 2024 – seven months ago!
Despite its vast resources, the ministry did not display current prices.
Yet the government expects private clinics and hospitals, with limited resources, to display prices of hundreds and thousands of drugs respectively.
While mulling over public statements made on the proposal for drug prices display, University of Chicago Ralph and Dorothy Keller Distinguished Service Professor Emeritus of Economics Dr Sam Peltzman’s and the late American economist and Nobel laureate Dr George Stigler’s economic analyses of regulation come to mind.
The Peltzman-Stigler model is a framework that explains the relationship between special interest groups and government regulation, i.e. regulation is often designed to benefit special interest groups rather than the general public.
The special interest groups use their political influence to shape regulations such that it creates barriers, protects their market share and generates economic rents.
The model emphasises that politicians and regulators may be motivated by their own self-interests, like seeking political funds or future job opportunities, rather than solely serving the public good.
George Mason University Duncan Black Professor of Economics and Law Dr Peter T. Leeson and University of Mississippi assistant professor of economics Dr Henry A. Thompson highlighted three themes in their 2023 review “Public choice and public health” in the Public Choice journal:
- Public health regulations are often driven by private interests, not public ones.
- The allocation of public health resources often reflects private interests, not public ones.
- Public health policies may have perverse effects, undermining instead of promoting health-consumer welfare.
What motivated the proposal to display drug prices is for the reader to decide.
However, critical healthcare cost containment strategies omitted in BNM’s recommendations include:
- Healthy lifestyle promotion
- Increasing screening uptake
- Improving health literacy, especially about non-communicable diseases (NCDs) and the need for optimal NCD control to prevent complications
- Capping of drug prices
- Ceasing governmental drug procurements through intermediaries
- Display of prices of health insurance policies for the public to make informed choices on purchase of policies
- Addressing “cherry picking” (or “cream skimming”) in which insurance coverage is provided only to those less likely to file claims, particularly non-coverage for senior citizens above certain ages.
In summary, the display of drug prices in private clinics and hospitals will increase healthcare costs for patients.
It may even lead to private clinics stocking fewer drugs, which could result in sub-optimal care consequently.
Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. For more information, email starhealth@thestar.com.my. The views expressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
