Collusion practices inflate medicine prices<\/p>\n
By K. Basrie<\/p>\n
JAKARTA (JP): Although he no longer chairs the influential
\nIndonesian Medical Association, Kartono Mohamad remains
\nauthoritative in medical affairs.<\/p>\n
He is now chief editor of Medika health magazine.<\/p>\n
When leading the association from 1985 to 1994, he submitted a
\nlist to the health minister at the time, Adhyatma, of 500
\npractitioners he alleged colluded with pharmaceutical industries
\nand inflated medicine prices.<\/p>\n
"The minister turned a deaf ear to the report," says the 57-
\nyear-old former navy medical staffer and writer of Legal Aspects
\nand Medical Ethics in Indonesia.<\/p>\n
Kartono shared his views in an interview with The Jakarta Post
\non the state of current medical affairs in Indonesia. The
\nfollowing are excerpts:<\/p>\n
Question: What's your opinion about the current price of
\nmedicines in Indonesia?<\/p>\n
Answer: Medicine is too expensive for most people. For
\ninstance, a five-gram tube of penicillin costs over Rp 10,000
\n(US$4.25). So how could ordinary people like those in remote
\nvillages afford to buy it?<\/p>\n
My recent comparative study in Bangkok on drug prices in
\nIndonesia and Thailand found that medicine in Indonesia is much
\nmore expensive than in Thailand.<\/p>\n
Yet the Indonesian government and the pharmaceutical industry
\ninsist that not all types of medicine are costly. They may be
\nright, but I do not know of any medicine that is cheap in this
\ncountry.<\/p>\n
People consider that prescription drugs are very expensive,
\nbut the government and the pharmaceutical industry don't think
\nso.<\/p>\n
Health authorities claim the prices of certain types of
\nmedicine are almost the same as those in Singapore. It seems to
\nme they ignore the difference between Singaporeans' and
\nIndonesians' buying power and per capita incomes.<\/p>\n
What about drug prices in other countries?<\/p>\n
Thailand has a per capita income of $2,680 (Indonesia's is
\n$940) but medicine is cheaper there. Some types of medicine in
\nBangkok are twice as cheap as those here.<\/p>\n
In Singapore, the price is slightly lower than it is here but,
\nkeep in mind that their per capita income is much higher
\n($26,400) than ours.<\/p>\n
People point their fingers at the government's slack control
\nof the pharmaceutical industry, the greed of some businessmen and
\ndoctors and patients with no bargaining power in the situation.
\nWhat do you think?<\/p>\n
I absolutely agree, although I know many parties reject this
\nidea.<\/p>\n
The government is not serious in controlling the
\npharmaceutical industry and this problem has been going on for
\nmany years. In the past, it let the pharmaceutical industry
\nmushroom, disregarding the actual market demand.<\/p>\n
Consequently, 250 factories operated below capacity and set
\nhigh prices to compensate for the high overhead costs. Had the
\ngovernment controlled the number of factories in the early years,
\nI believe it would have resulted in efficiency, which would have
\nled to lower drug prices. I don't know why the government made
\nsuch a mistake.<\/p>\n
But the rule of thumb shows the more factories, the lower the
\nprices would be, doesn't it?<\/p>\n
That happens with other products. It's wrong to assume that
\ndoctors will readily recommend cheaper drugs for their patients.
\nThe government's slack control allows drug producers and doctors
\nto dictate prices, while consumers have nothing to fight it with.<\/p>\n
Many doctors just scribble the prescription and don't care
\nabout prices and their patients' financial conditions because
\nthey never buy drugs. Drug producers know how to collude with
\ndoctors and exploit this situation.<\/p>\n
What may the corrupt doctor receive from the drug producer in
\nreturn?<\/p>\n
It depends on the amount of profits raked in. I could show you
\na noted specialist who got a car from such a conspiracy.<\/p>\n
How reliable is the medicine recommended by such a doctor?<\/p>\n
They don't care. What they would choose is the drug whose
\nproducers offer the best "deal", while the patients are ignorant
\nof the conspiracy.<\/p>\n
Corrupt doctors never run out of tricks to blackmail drug
\nproducers. For example, some practitioners will threaten to
\nboycott certain medicines unless the supplier or producer gives
\nthem money to attend seminars.<\/p>\n
Isn't such a practice in violation of the practitioners' code
\nof ethics?<\/p>\n
They do violate their oath and code of ethics. It is rampant,
\nand nobody does anything to stop it. Neither do the
\npharmaceutical industries and their partners, which compete with
\neach other.<\/p>\n
How many doctors are involved in this dirty business?<\/p>\n
Their number is less important than the fact that the practice
\nexists, often well-organized. The blackmailed suppliers or
\nproducers do not dare do anything for fear their products will be
\nboycotted.<\/p>\n
Are there any public officials involved in this business?<\/p>\n
Yes. It is common for officials to use their power for
\npersonal benefits. Many drug companies have complained that they
\nhave been blackmailed into providing cash amounting to hundreds
\nof millions of rupiah (by the certain people in power) for
\ndubious purposes. To make up losses, they inflate the prices of
\ntheir products.<\/p>\n
What has the doctor's association done to help victimized
\npatients?<\/p>\n
When I was chairman of the association, I brought a list of
\nover 500 corrupt doctors along with a bulk of material evidence,
\nsuch as receipts of illicit levies, to the then-health minister,
\nAdhyatma.<\/p>\n
I urged him to take stiff measures against the doctors who we
\nbelieved had caused medicine prices to soar as the result of
\ntheir conspiracy with pharmaceutical industry owners. But the
\nminister never took action against the culprits.<\/p>\n
Our efforts ended up in the trash bin. It seems that the
\ngovernment is not concerned at all about this problem.<\/p>\n
What about the Indonesian Consumers Foundation?<\/p>\n
What the foundation does is no more than advocacy. Moreover,
\nthe House of Representatives is not supportive of the agency.
\nAnything it does without the House's support is useless.<\/p>\n
Why do customers never complain?<\/p>\n
Even I am surprised. Maybe it is because our society is
\nfatalistic. But I believe the educated class should do something
\nto mend the situation.<\/p>\n
What is your suggestion?<\/p>\n
Simple. Make this topic an open discussion in the media, so
\neverybody -- including the government, the public and the
\nindustry -- can do something.<\/p>",
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