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.
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