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 Azrul Mohd Khalib, CEO of the Galen Centre for Health and Social Policy.
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00:00hello and good evening i'm melissa idris welcome to consider this this is the show
00:15where we want you to consider and then reconsider what you know of the news of the day in an effort
00:20to curb rising medical costs the government has announced that starting may 1st all private
00:25healthcare facilities are required to publicly display the prices of all medicines they sell
00:31supply or administer however this policy has sparked some debate so tonight on the show we'll
00:38consider how this policy might affect both private healthcare providers and also patients joining me
00:46on the show is azrul mohammad khalib who is the ceo of the gallant center for health and social policy
00:53azrul welcome to the show um the gallant center put out a statement recently saying that the drug
00:59price display policy could actually backfire and uh worsen medical inflation i was curious about that
01:07could you elaborate how do you see this policy doing more harm than good thank you melissa you
01:14know uh when you look at it from a theoretical standpoint uh mandating price display for drugs
01:21and medicine in private hospitals clinics dentists and pharmacies could actually inform and empower
01:28consumers to you know compare out-of-pocket costs and and choose lower cost options and perhaps even
01:34introduce competition between healthcare providers and this enables there to be some sort of management
01:40for the prices of pharmaceutical products through free market forces and that's what we have in malaysia
01:46uh free market and uh price display isn't new uh if you go to a pharmacy today you see them they've
01:52been doing it for decades uh and so displaying prices is a reasonable action uh which makes uh medicine
02:00pricing more transparent uh i mentioned just now possibly competitive uh as they are currently usually
02:06bundled uh into clinic hospital fees and uh you can actually decide uh whether to fill your
02:13prescription at the clinic or hospital or go to a pharmacist currently there's a mistaken assumption
02:19that you have to go to the clinic or be forced to get your medicine at the clinic that you visited
02:26now that's that's not true you can actually take the prescription they get from your doctor and fill
02:31it in at the nearby pharmacy and so forth so the the issues here are basically that uh that the drugs
02:39are the medicines that are being prescribed to you you should be able to uh uh shop around basically and
02:48and find out what's the best deal you can get but the problem here is this melissa unlike everyday
02:52products you know like eggs chicken fish and other staples the names types and formulations of drugs
02:58are largely unfamiliar to patients uh who largely depend on uh medical health professionals to advise
03:05determine and prescribe what is needed for the treatment now patients are even advised to refrain
03:11from depending on their own research or depend on dr google you know and how will consumer choice
03:17work when this is an area needing specialist knowledge to decide on what drug dosage frequency
03:22application you know there's oral intravenous subcutaneous should be administered it could
03:27even bring about patient harm or adverse events due to inaccurate intake of the drug so
03:33there's a problem here when we talk about economic theory and the invisible hand so to speak because
03:38it's very hard for there to be a reference here or standard to measure against when the person
03:42themselves don't know so my worry here is this is that private hospitals clinics and pharmacies you know
03:49god forbid could basically collectively and collaboratively even mark up the price of drugs
03:55currently uh even higher after adopting price displays because you know patients just are not likely to
04:01know what the recommended retail price uh for the specific medicines are before andrian treatment
04:07and it's instead of curving medical inflation this actually could be inflationary and that's not even
04:12including wastage that is possible you know because you think that you go to a pharmacy you can get a cheaper
04:19deal but actually what happens is the prescription that's given by the doctor is very specific to what is
04:27being treated so it's a duration how many pills you have to take a day for what duration but in the pharmacy
04:33you could be forced to buy a box instead of the exact prescription that's given by the doctor because
04:39pharmacies don't sell you know like just a slab perhaps or just a few pills they maybe sell boxes
04:45or uh you know so it could actually cost more by visiting a pharmacy okay so so from what i understand
04:53from some of the um medical groups is that the concern is not so much about the price transparency
04:59but rather what uh legislation it falls under so what is what is its punca kuasa essentially and
05:06there's been concern that it doesn't fall under the private healthcare facilities act that it falls
05:10under the price control and anti-profiteering act help me understand why that is a concern
05:16well actually i think in this particular case the medical professionals are very
05:20uh concerned that they are overlapping uh legislation that is governing healthcare
05:27and the reality here is is that malaysia doesn't have a specific legislation to look at price marking
05:35of pharmaceutical products so if you look at the legislation i think it was mentioned the private
05:40healthcare facilities and services act uh the poisons act and the sale of of drugs act these are all very
05:48much linked to the uh monitoring the regulation of quality efficacy of uh the services and the drugs
05:56that are being sold but it doesn't deal with the price marking and that's where price marking is only
06:03provided for under the legislation that everybody's quite concerned about which is the uh one that deals
06:09with price control and anti-profiteering act with the 1333 so unfortunately in this particular case
06:16we actually have to refer to that particular legislation to regulate uh price controls but you know the
06:24the issue here uh uh price marking sorry uh melissa so the problem here is really this uh the pride
06:32clinics really uh when you look at it what their main issue here so the the problem here is that it could
06:38affect uh their uh business and private clinics depend on two main sources of revenue consultation fees
06:47and charging for treatment which is where the drugs are now the fees have been the same and frozen for 33
06:54years it's stuck at 35 ringgit how else are clinics to make money other than charging for medicine and
07:01treatment and care with a profit margin you know you've got to pay salaries overheads and don't forget
07:06also there's also in malaysia the use of third party administrators or tpas by employers which
07:12are organizations to handle all the medical claims and related services for bigger companies employers
07:18and other groups and they charge a commission on their services so health and in this case gps
07:23are businesses after all and you know these uh are concerns for which the policy is not being implemented in
07:30in vacuum and i have to stress this that consultation fees have been in stasis or limbo for 33 years
07:37okay you pay more to a locksmith or for a plumber and even a bottle of shampoo when compared to gp
07:43fees at 35 ringgit so so you're saying address also consultation fees while looking at this but talk to
07:51me about the so you talked about how gps are also a business right isn't this policy meant to confront
07:59profiteering in private health care because we have heard of claims of of medicine markups as high as
08:06you know uh several hundred percent some claim but um wouldn't this help then address those issues
08:13well you know again when we look at it in uh context uh the percentage may sound huge but the amount may
08:20not be so so we have a situation where because there is this fixed fee for which you cannot go beyond
08:28and for gp fees it's between 10 ringgit to 35 and specialist it's between 80 to 235 stuck since 1992
08:37you cannot go more than that so if you are going to go more than that and bearing in mind inflation goes
08:43up you know cost of living and so forth the only thing that you can adjust is really the price of
08:49medicines uh the treatment fee the treatment itself so if you get something for two ringgit for example uh
08:57and uh say a slab of panadol it costs two ringgit if the gp sells it for four ringgit that's a hundred
09:04percent increase right but it's just four ringgit so when you look at the different drugs there are markups
09:11it's either in like 10 percent 15 or even three hundred percent depending but not exorbitantly so
09:18and this is because the reality of it is is that uh the inflation rate that also affects uh gps
09:25uh being transferred to patients themselves so it does cost a little bit more but the effect of the
09:32advantage is is that a lot of people go to gps because of the services that they're able to provide
09:39the convenience the ability to access immediate care as opposed to waiting for hours at a kk or
09:46government clinic or having to wait you know to go for an x-ray or to get uh some minor surgery done
09:53which you have to wait maybe longer at a government facility so it's important that we compensate them
09:58for these services right so talk to me about whether you think this policy is fundamentally
10:05flawed or should there be other measures that accompany it that will help reform the the sector
10:12and and achieve the the results that the government wants to achieve while protecting all the the
10:16ecosystem that's already in place well melissa i don't think the policy itself is flawed i think
10:22anybody would be uh reasonable to expect that whatever you buy whatever you procure
10:27should have a price tag on it and we want to be able to compare uh you know but uh medicine isn't
10:34easy uh or such a thing that we can do window shopping you know it's not that straightforward
10:39we actually have to have a guided discussion with your healthcare practitioner to be able to ensure that
10:45we are getting the right drugs for the right purpose and taking into consideration things like
10:50allergies adverse events and so forth which could do us more harm so the problem here is this and we look at
10:56the pragmatic uh application of uh this piece of policy that is going to be put into place is that a
11:04private clinic could have a hundred drugs in its disensory uh in a pharmacy you have thousands uh which
11:12would need to be listed yeah under this law so this policy should the price display be in the form of a
11:18transparent folder you know like all those malaysian graduates displaying the academic certificates
11:23uh should it be on like a one sheets of paper and then you put it on the clinic uh you know waiting
11:30room so instead of all those posters telling us to reduce cholesterol take care of your health
11:35cut down on your sugar now you have lists of all the drugs and equipment that there are so how often
11:41will these lists need to be updated how much detail is going to have to be in there to ensure compliance
11:46because what we want to also uh make sure that this isn't a gotcha moment yet for enforcers to trap
11:52healthcare facilities to non-compliance and the fact is that there are many challenges here to
11:57regulatory compliance you know because one of the things that could be quite worrying for patients is
12:03that this could actually force private clinics to just eliminate or do away with their dispensary
12:08altogether because the regulatory burden is too much you know they say oh forget it i'm just going to
12:14not have a dispensary i'm not going to dispense medication at all i'm just going to provide
12:19consultation which basically means there is a practice of dispensing separation where doctors
12:25provide diagnosis and treatment and then medicine is collected from a pharmacy via prescription
12:30because it could be just too much of a burden maintaining an on-site dispensary and they might
12:36decide that it's just not worth it despite the loss of income and you can see in other countries
12:42that there is dispensing separation is that the goal for malaysia as well do we want to encourage
12:47dispensing separation well i can tell you malaysian patients are going to be grumbling they're going to
12:52protest against it because people like it we are very fortunate here in malaysia where we can go to a
12:58clinic you know within a short period of time just walk out the door go to a clinic you see the doctor get
13:05a prescription and get your drugs right there and then you can spend like maybe an hour or two and
13:11you can get that process all done in other countries where there's dispensing separation uh to just see
13:18the gp could take two weeks in the uk you get an appointment to see the gp after which you get a
13:23prescription and then you get the prescription you have to go to a chemist or pharmacist to get the drugs
13:30and it takes a whole long time and it could take more time than you could actually afford whereas
13:36here malaysia you get your medication at the same place that they're diagnosed and treated and here's
13:41the thing a lot of people don't know that if they feel that after the first visit that they can't
13:47afford the treatment particularly if they're paying out pocket it's not panel doctor you can
13:52actually just go to a public clinic or hospital instead or take that prescription that the the
13:58government sorry take that prescription that the doctor has provided to you and fill it at a pharmacist
14:05so the problem here is is that one additional worry for me uh melissa is that the drug price display
14:11could also hamper or restrict the ability of healthcare providers to provide collective package
14:16bundling you know where you have a single payment and it covers multiple uh healthcare services and
14:22supplies for a specific episode of care and it might introduce a rigidity into the costing of
14:28pharmaceutical products where right now you know you have discounts or bundling uh which you benefit
14:34from uh and it's very important to to mention that because a lot of the uh the community clinics you
14:42know the gps they know a patient they say oh it's okay i'll give you a discount and then it becomes cheaper
14:48right so i'm worried that it will affect the ability for patients to access the care that they need
14:54as well thank you so much for joining us on the show as well from the garden center
14:58for health and social policy we're going to take a quick break here and consider this
15:02we'll be right back stay tuned