Public ailing over acute drug crisis

Expensive as it may be, many Indonesians have no choice but to pay increasingly skyrocketing prices for indispensable medical supplies. The government is doing all it can about the country's dependence on imported health drugs and equipment. Stevie Emilia of The Jakarta Post and contributor Rita A. Widiadana have compiled the accounts of medical experts, officials and those who must take care of sick loved ones.

JAKARTA (JP): "Anita" almost choked when she paid her mother's monthly medical bill early last week.

It cost her roughly Rp 2 million (US$200) to purchase insulin, a dozen disposable needles and other equipment to treat her ailing mother who suffers from diabetes.

"It was shocking," said the mother of three. "A few months ago, the medicine cost only Rp 300,000. Now, I have already spent two-thirds of our salaries to purchase this medicine. I really don't know how we will buy food and other basic necessities."

Spiraling medical costs, not to mention food costs, have made the lives of Anita and many others much harder to bear.

"When staple foods became rare and expensive, we could still find alternatives," Anita said. But as medicine becomes increasingly expensive and hard to find, she added, were people supposed to stand by and let sick family members die sooner or later?

Last month, a legislator visiting Cipto Mangunkusumo Hospital said 2,000 outpatients with kidney failure were considering giving up their vital dialysis treatments.

Each treatment, which involves a hemodialysis unit, cost Rp 140,000 last year. Currently, the treatment costs Rp 572,500.

Another observer reported that hundreds of women in West Java delivered their babies at home without proper medical help because hospital costs were deemed to be too high.

Samsi Jacobalis, former chairman of the Indonesian Hospital Association (Persi), was not sure whether all the reports were true. But he stressed: "The lives of thousands of patients are at stake..."

Former minister of health Adhyatma emphasized the plight of the country's poor. With food becoming increasingly expensive, he warned of a decrease in nutrition levels for many Indonesians.

"A lower nutrition level is dangerous, especially for pregnant women and children under five. It could contribute to the increasing infant and maternal mortality rates, which are already high now," he commented.

Blame

The rupiah has depreciated in value against the U.S. dollar about 75 percent since last July. The weakened currency has been blamed for the soaring prices of medicines and medical services which have increased between 45 percent and 300 percent.

The dependence and "fascination" with imports, including sophisticated medical equipment, has led to Indonesia's incapacity of even producing basic equipment like disposable needles, said Askobat Gani, dean of the University of Indonesia's Public Health School.

Ministry of Health figures show that the government spent $178.32 million last year to import up to 90 percent of the needed raw materials for 201 types of generic drugs.

Minister of Health Sujudi has urged patented drug manufacturers not to drastically raise prices as many people are still dependent on types unavailable in generic form.

Prices of patented drugs have reportedly increased up to 300 percent, while generic drug prices -- relatively stable since l993 -- have soared by as much as 150 percent in the past few months.

Medicines have been running short as pharmacies say their letters of credit have been rejected by foreign banks, thus hampering the purchase of raw materials.

To help ease the situation, the Ministry of Health has announced that the government would allocate $116 million (at the state budget's fixed exchange rate of 5,000 to the U.S. dollar) to help state-owned pharmaceutical companies import raw materials to produce drugs for the next six months.

After meeting President Soeharto early last month, Sujudi said the President had approved an additional subsidy of Rp 700 billion for imported generic drugs and life-saving medical equipment. He added that a letter of credit worth $58 million had been issued to help cover pharmaceutical needs for the next three months.

While strongly urging medical centers not to raise fees, Sujudi asked hospitals and doctors to launch efficiency drives and to use more generic drugs, still dismissed by many as low- quality medicines.

The spiraling prices and increasing scarcity of medicines come on top of the fact that for years, consumers here have had to deal with drugs that are already considered expensive.

A World Bank report on Indonesia said that in 1994, households spent on average one-third of their expenditures on medicine, while being able to buy far fewer quantities of medicine compared to other countries.

A study in late 1995 by the Indonesian Consumers Foundation (YLKI) also revealed that drug prices in this country were up to four times higher than in some other countries.

The cause of the high prices has been blamed on collusive practices which not only lead to more expensive drugs, but also involved doctors prescribing expensive medicines in cases where cheaper ones would be just as appropriate.

Adhyatma acknowledged that collusion was a problem and that it involved patented, not generic drugs.

Another source said patients should be able to acquire relatively cheaper drugs, but that existing guidelines made doctors consider low-cost drugs outdated.

Sri Suryawati, director of the University of Gadjah Mada's Drug Policy and Management Post Graduate Program, was quoted by Republika daily as saying that the guidelines "contain all information concerning drugs of choice and accurate medication for every kind of disease already proven by scientific, ethical and clinical tests."

"By applying this guideline, doctors could use low-cost but potent medicines...," said Suryawati, also the country's coordinator of the International Network for Rational Drugs.

What makes the situation even worse, is that few of the country's 200 million people have health insurance. State-run health insurance company Askes, which covers only 16.5 million people, has yet to cover the purchase of many high-cost medications. Askes clients are mostly state-run company employees who pay 2 percent of their monthly wages for their coverage.

Daldiyono H., a professor at the University of Indonesia's Public Health School, said: "In prosperous times, we always forget how to make everything more efficient. Now, the people must suffer (as a consequence)," he wrote in the Kompas daily, referring to what he said were unnecessary costs for hi-tech equipment used for medical check-ups and diagnoses.

Patients, he said, should be more knowledgeable of their rights to receive quality health care.

To avoid more expenses, Samsi said, people would do well to stick to the old adage that prevention is better than the cure.

But the financial troubles "could worsen people's physical and psychological condition regardless of social status," he said, from business owners struggling in debt to the newly unemployed.