In an effort to curb rising medical costs, the government has announced that starting 1st of May, all private healthcare facilities are required to publicly display the prices of all medicines they sell, supply, or administer. However this policy has sparked debate. How might this policy affect both private healthcare providers and patients? On this episode of #ConsiderThis Melisa Idris speaks with Dr Lim Chee Han, Senior Researcher for Third World Network.
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00:00Hi, welcome back to Consider This. I'm Melissa Idris. Let's continue our conversation about the
00:15government's mandate that as of 1st May, that healthcare professionals or healthcare providers,
00:22private healthcare providers, are required to publicly display the prices of the medicines
00:26they sell, supply or administer. Joining us now to discuss this further is health policy researcher
00:33Dr Lim Cheehan, who is the senior researcher for the non-profit advocacy group Third World Network.
00:41Dr Lim, thank you so much for being on the show with me today. As an overview, how do you see
00:45this mandate requiring medicine price displays? Is it a positive thing or a negative thing for
00:51consumers? Thanks, thanks Melissa for having me here. Yeah, oh, that's definitely a positive move
00:58for consumers and patients alike. Why is that? Because for so long in Malaysia, medicines have
01:05been strangely exempted from having to display prices in the private healthcare sector settings.
01:11The consequences actually are quite disastrous because medicine prices in the private healthcare
01:16care settings are generally higher with very high markups on the items and a very wide variation of
01:25a price range of the same product. I just want to give you some numbers according to the medicine
01:29prices monitoring in Malaysia survey 2022. The average markup on generic medicines in private clinics is
01:37140% and in the private hospital admission which is actually 280%. That's just an average, let me remind
01:49you. And the average price variation for particular medicine can be 200% in private clinics which means
01:58you will be very often find one clinic sells a medicine at RM10 while another clinics may sell it at
02:05currently just next door. So you have to ask yourself why there is such a wide price variation and why the
02:13markup can be so high. So I would like to point out that the consumers and patients have actually have no way
02:18of knowing the selling price of medicine in these facilities. So without such information, they actually
02:24cannot compare and choose. So they cannot make an informed decision based on price. Often they only, yeah.
02:31Right. Sorry, if I may just interject here. So you're saying the transparency will benefit consumers and
02:37they can kind of shop around for a more competitive price or one that suits their budget. There are those
02:42who say that this might disproportionately affect small clinics and GPs which at the end of the day are
02:49businesses. Their consultation fees have not been revised for over 30 years. What's your response to those who
02:56worry that while it's well-intentioned, it could make it harder for the very vital primary care
03:03providers to survive? And some of the markups, while they may sound big in percentage, actually are small
03:11in amount, maybe even a few cents or ringgit. How would you respond to that, Jihan?
03:16Yeah, I do support their call for revision of the doctor's consultancy fee because it has not been revised for
03:24more than 30 years. It's rightly to do so. But I think they should not confuse that revision of the
03:32consultation fee with other item policy like drug price display because one thing is we talk about
03:42the transparency. I think it's the consumer rights to know our prices. Another is their revenue. They have
03:50to go back to the root of their problems to solve it from there. And the minister already promised
03:57that he would deal with it and promised to revise within this month. So we should wait and see.
04:06Okay, alright. So what other measures do you think should accompany the price display mandate? So you
04:11talked about revising the consultation fees. Anything else that you think would make it more effective if the
04:18primary objective of government is to tackle medical inflation, reduce medical costs?
04:25Yeah, actually before this drug price display policy, actually the government has this policy called
04:32medicine price mechanism. The original policy is actually dated back in 2019 where the cabinet under
04:40the Pakatan Harapan 1.0, under the health minister to give free, actually have the mandate to regulate the
04:45markups on the single source medicine which are mostly the patented original medicine. At the retail
04:52level and drug manufacturer and importers have to declare and set the maximum wholesale prices at the
04:57same time. But you know that because of a very strong objection from the industry, the ministry actually
05:04backing down and watering down right now just to ask the retailers and the healthcare facilities to
05:10declare prices. This is actually not a price control because they can still set the margin higher and
05:16we all understand right now because of their doctor's consultation fee and what so on. We understand
05:24they can set the margin higher. But I think as times go on, if the problems of their, for example, their
05:31consultation fee has been revised. So I think we have to go back to the policy where the fairness, the market
05:38competition should be emphasized. Yeah, so the right for the consumers to know the prices so they can make
05:45the best plan for the affordable healthcare savings. I mean, this is very important to them also.
05:53I understand. Chihal, consumers like myself, we have limited knowledge about pharmaceuticals. We don't really
06:01understand, you know, any dosage and type. I can't even name the same, the brand names of some of the
06:10medicines. So how would consumers with that, with not enough information with, without that specific
06:17knowledge, be able to use this price display to our advantage if we don't know what we're looking for?
06:30How would you advise consumers with limited medical knowledge to understand? What do we need to
06:34understand about the price of medicine and about how it's determined? Yeah, I think it's a very good
06:40time for the consumer and patients to learn about medicines because we need to know there are two
06:47kinds. One is called originator, one is called generic medicines. So usually when the medicines are new to
06:53the market, there are only one medicine available, which is the originator and visually it's the highest,
06:59command the highest premium in terms of price margin. So when there is the the the patents for the
07:05medicine expires, the generic medicine comes in and usually the prices of the originator will drop by
07:11at least half compared to the generic. So don't be worried because generic medicine in Malaysia meet
07:18very high standard and on of the regulation. So they have the same efficacy, same safety and quality
07:25features as the originator. So if you have a chance, if you have a choice to
07:29buy generics, you can actually save a lot of money. Okay, all right. So it could be to the benefits of
07:38consumers if you make informed decisions. May I ask you if this has worked in other countries?
07:45Whether the displaying of drug prices in healthcare providers, whether there has been evidence
07:55that it has led to better medical inflation control. Actually drug price, transparency policy and
08:04mechanism is actually recommended by WHO back in 2019 and Malaysia is our core sponsor to one motion at
08:12the World Health Assembly on this motion. I think it's an international good practice because without the
08:19transparency, there is no healthy and fair market competition where the practitioners can just set
08:27any price they want and the consumers and patients do not know what are the selling prices until when they
08:34receive their bills and often they receive the bill without the detailed itemized bill. So actually
08:40they know how to, in that case, you won't see the price go down because they can just do so,
08:48setting at the high prices. So price transparency is not a guarantee to keep everything, the prices low,
08:55but it's a very necessary first step because without transparency, nothing will work.
08:59I understand. So are you concerned that there could be any, I was going to say adverse reactions but
09:07that's too much of a pun, any unintended consequences from this policy if it's not implemented well, if it's
09:15not rolled out with, you know, given enough consultation with the stakeholders and allowing
09:21stakeholders to adapt or adopt it well? I want to clarify about the not enough consultation. Actually,
09:29the government has been engaging with the industry for over six years since 2019 on the various price
09:37mechanisms. So you cannot say the industry doesn't know that what is coming but I think in this policy
09:44government has given a leniency period and for education for them to make the practice right. I think
09:50once everyone's doing that it's just a norm then I think there's just the initial state you have to set up
09:58something, a template. Other than that, after that, you just adjust the prices. I think it's easy work.
10:04And when they do the good inventory stocking, I think this just comes naturally in the digital world.
10:10Okay, well thank you so much, Chihan, for giving us some of your perspective and analysis about this
10:17policy. That was Dr. Lim Chihan from the Third World Network wrapping up this episode of Consider This.
10:23I'm Melissa Idris signing off for the evening. Thank you so much for watching and good night.