Medicine prices: A horror story

The Jakarta Post's headline story about the prices of medicine (Sept. 15, 1996) quoted me as saying: "They are criminals," with the "they" implying "government employees, pharmacy owners and medical practitioners" without further characterization. This is a statement that should be regarded in the context of the conversation, and should be addressed to the act instead of "they".

Although medicine prices in Indonesia are not the cheapest in the world, for old generic drugs the cost is quite low. But for many pivotal drugs, as can be seen in the table provided in the same Sunday issue, the prices are exorbitantly high.

In discussing why it is so, I talked about government health and drug policies, drug pricing policies, high profit margins in the drug chain and the extent of irrational prescribing. I also questioned the inaccessibility (to prescribers) of an unbiased drug information source, the untouchable industry-medical complex, pharmacy stores that overcharge for prescriptions, and the pharmaceutical industry which offers kickbacks to prescribers in return for prescribing their drugs, and other immoral marketing practices.

Clinical laboratories are doing the same, by the way. I also discussed the fact that many young doctors in Indonesia do not earn enough to live decently. There are doctors who run from one hospital to other hospitals to increase their income.

The lack of health insurance for most people and out of pocket payment for health services are problems that can result in unnecessary suffering and even death. The unethical attitude of health services exists merely to increase income. Other problems include spiraling prescription costs and the increased side effects that occur when multiple drugs are being used.

If one looks at the problem and the complexities that cause these to occur, can one then wait patiently until some wise guy has the guts to regulate all this? Can we trust our health system? If we do nothing to improve the situation now, it may well be too late for a change because wrong concepts and values are becoming accepted as normal.

DR. IWAN DARMANSJAH

Jakarta