Medicine prices

Medicine prices

I am gratified to see that health care issues are finally
getting the attention they deserve (Medicine Prices Tell A Horror
Story, The Jakarta Post Sept. 15, 1996). I applaud and commend
the contributors.

However, I was taken aback by the statement that "health is
nothing more that someone has to purchase in the form of
medicines."

Treatment of disease involves the purchase of medicines but
also the doctor's skill, the laboratory, procedures, and a host
of other "purchases" as well. Anyway, "health" is not a "simple"
anything; it is a complex interaction of genetics, environment,
lifestyle, and other factors. The statement is erroneous and
misleading.

It should also be acknowledged that while pharmaceutical costs
may be high in Indonesia, the total costs (drugs + doctor + lab +
etc.) are low as a percentage of personal income and as a
percentage of national GDP. In fact, physician compensation
levels are so low that most doctors are forced to seek other
revenue streams just to survive. This is not to condone the
unethical practices described in the article but to identify one
of the major reasons behind them.

The problem of drug and health care costs is complex. Studies
by the Ministry of Health over the last seven years have revealed
that polypharmacy (excessive/multiple prescriptions) is a real
problem, especially since many of the drugs are not useful (as
stated by Dr. Iwan). Conversely, there is also a tendency to give
insufficient amounts of the correct drugs. As much as 40 percent
of drugs are wasted.

A major underlying problem is that the majority of Indonesians
still pay for medical care out of their own pockets. Hence, the
sick bear the burden of health care costs. In all developed and
many developing countries, widespread risk-pooling through health
insurance or social insurance schemes addresses this problem.
Unfortunately, these schemes have precipitated their own problems
and most systems are undergoing radical reforms or even
dismantlement with a general trend towards what is called
"managed care".

The Ministry of Health and the Indonesian Medical Association
have taken substantiative corrective steps. Aside from developing
standards of care for the 100 most frequent diseases, a hospital
accreditation system, and a strategy called Rational Drug Use, a
"managed care" strategy known as JPKM was promulgated in the
National Health Law #23 in 1992 which holds the solution to the
drug cost problem and, indeed, the entire health care cost issue.

As enrollment in the JPKM program increases, both the cost of
drugs and waste will be reduced. The individual who is ill will
be protected from the full financial burden of health care. The
standard of medical care will rise in Indonesia and most
importantly and hopefully the health of the nation.

The pharmaceutical costs problem is a symptom, not the
underlying cause. If the issues of health care financing and
quality of care are addressed directly, the drug cost problem
will correct itself just as treating a case of pneumonia with the
correct antibiotics will rid the patient of fever. If you treat
the symptoms but not the cause, the patient will not heal and the
problem will merely arise in a different place.

Finally, I urge you to continue to focus on health care. The
public needs to know. You can't take advantage of education and
business opportunities if you are sick. Health must come first.

Name and address

withheld