I REFER to the comments made by the learned deputy dean, School of Pharmacy, KPJ University College in “Don’t fear Pharmacy Bill” (The Star, April 25).
In general, I am in agreement with most of the comments made by my esteemed apothecary counterpart. His comments about the singularity and expertise of pharmacists with regards to the knowledge of “poisons and medications” could not be more accurate. After all, this is a profession which has dedicated itself to the art and science of remedial compounds. It is a “no-contest” situation, with pharmacists deserving to be held in high regard for their expertise in remedial compounds.
The “battle” between doctors and pharmacists, in my humble opinion, is one that is more driven by financial motivations rather than the focus on what is good for the patient. There has been so much written by both parties justifying the reasons why separation should or should not occur. I read, often with embarrassment, how members of both sides have stooped so low in order to protect, and even grow, their rice bowl.
From a purely academic standpoint, it is without doubt that separation of dispensing will lead to better and safer patient care. Let the experts do what they do best, and patients would be very well served. Unfortunately, it is the implementation and, more worrisome, the financing and logistical issues which concern me, as so it should the general public.
Firstly, my learned colleague had inaccurately written “The minority of patients who enjoy healthcare financed by health insurers….”. Being a doctor with healthcare administration experience, this can be no further from the truth as 60-70% of private medical care is now funded by such insurers, TPAs and corporations with employee medical benefits. In fact, it would be safe to say that without company and insurer-funded medical programmes, private medical institutions would fail to thrive. Healthcare costs are indeed increasing globally and separation would only add fuel to the fire.
In the present system, anyone paying for GP care would know that the doctor’s consultation rates are heavily subsidised by the margins made from the dispensing of medications. The prescribed consultation rates under the MMA Fee Schedule provides a range of between RM30 and RM125 per consult. But go to any GP these days and you would find that these rates are being charged anywhere from RM10 to RM30.
It is true then that GPs earn a living through dispensing. However, take this away and the situation will flip around completely. Without the margins from dispensing, GPs will have no choice but to charge at the prescribed rates mentioned earlier.
The companies will have no choice but experience up to a four-fold increase in the consultation rates alone. What used to be RM75 complete with medications will now be RM90 merely for the consult, minus the medications. Who will pay for this?
It has been argued that pharmacists would not charge any consultation fees. But they too need to make a living, right? This would come from the mark-ups and margins factored into the medications. Would there be any financial gains from this as compared to GPs dispensing? Or would the medication costs remain unchanged? Chances are, what is RM50 currently would remain at RM50. Simply put, separation of dispensing merely means that there are now two mouths to feed, or purses to fill, rather than just one. I fail to understand the economic arguments that my learned counterparts are stating.
The pharmacy groups would counter this by stating that separation is already in full force in private and government hospitals. However, they have not detailed that, in the case of the public healthcare system, the incentive mechanisms for doctors are not based on sustainability, much less profitability. This is a government-funded platform and no doctor in this system need worry about paying for operational and staffing costs.
In the case of private hospitals, specialists are already being paid what is fairly due to them, with consultation rates ranging from RM60 to RM240 per consult. Further, they are mostly holding third-party contractor status within the private hospitals and, similar to public-based hospitals, do not have to bear the operational costs of the hospital, much less foot the bill for any medical equipment which they need.
It is the poor GP who needs to bear all these costs while ensuring he has enough to bring back to the family table.
Ultimately, there will be a significant increase in the cost of healthcare. Some shortsighted enough would argue that with so many medical insurance programmes available, this is okay just so long as the consumers purchase these programmes. But insurers are business entities too, and such increase in the costs would only drive them to increase the premiums. Again, it is the consumers who will be the ones who end up paying the hefty price.
The pharmacists would have us believe that nations such as the UK, US and Australia have gone by way of separation of dispensing a long time go, and Malaysia needs to catch up. But these nations, and others, all have some sort of national health financing system. The consumer does not have to bear the full brunt, although they do pay through the form of higher taxes.
In Australia, for example, it is true that you get your doctors’ consultation and medications from the pharmacists at no cost, but you also pay up to 42% in income tax. Are Malaysians ready for this, and the inconvenience of having to drive or walk around looking for a pharmacy after they have seen the doctor?
Even the mere 6% for GST has caused so much ruckus and dissatisfaction. What would the income tax revision do to this already wounded sentiment among the consumers?
I am not against dispensing separation. I am a firm advocate of it. It’s the financial impact of such a move on the entire healthcare delivery system that I have a problem with.
It is the inconvenience that I will struggle with. And I have this strong suspicion that it won’t just be me when indeed we embark along this path. It’s really a case of the price Malaysians will pay, in the name of “progress”.
DR JUNAIDI ISMAIL
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