THE MALAYSIAN HEALTHCARE ; PHARMARCY SERVICES 2008 REVIEW

From the 30th Nov till 2nd Dec 2009, we ( the Federation of Private Medical Practitioners of Malaysia ) were invited to participate in a Pharmaceutical Services Division, Minitry of Health workshop in Port Dickson. It was held at the Corus Paradise Resort, Port Dickson. The workshop was entitled " Ensuring Fair Access to Medicines - Pharmaceutical Pricing Policies and Regulations ".
Of course, with such a title, our ears perk-up. It smelled like at attempt to regulate doctors right to use drugs of their choice, be it generic or branded, to use cheaper alternatives for the treatment of disease conditions, and even more alarming, the regulations to separate dispensing and prescribing. These are all important issues to resolve, as it will definitely affect the medical primary care landscape.
Even before we went for the workshop, we were very surprise at the choice of the venue. Why hold an important workshop away from KL and Putra Jaya, and at a run down 3-star ( at best hotel ). I suppose if you are a government servant, it makes more sense ( afterall it is jus after a long weekend ), to have a workshop in a resort town and hotel. However, if you are busy private self employed doctor or group practice, then you will wonder why. Be that as it may, we also noticed that, of the list of 46 participants, representing various Pharmaceutical divisions in Ministry of Health, EPU, and other pharmaceutical bodies, there were only two private medical associations invited, with 5 doctors listed as invited delegates to represent these private medical bodies. This was despite our protest in July 2009, at the last " Malaysian National Drug Policy mid-term review " workshop, that they must include more private doctors, as the topics discuss will impact on pprivate healthcare. Looks like they never bothered.
Anyway despite all these grouses, we went ( what choice do we have ), to say our little bit. The three of us from the FPMPAM took turns ( as we were private self employed practitioners, and we do need to earn our bread ). I learned a few facts from the lectures. I learned that we spend about RM 430M in 2000 on medicines ( 6.32% of healthcare budget ), in 2007, we spend about RM 1.3B on medicines ( about 10% of the healthcare budget ), and in 2008, we spend RM 1.5B on medicines ( about 11.7% of the healthcare budget ). This is a very reasonable number and is by no means excessive. There is little need to change or trim down, as what we are spending on medicines is the world average. Whatmore, to state that our healthcare system has produced outcomes, as measured by life expectancy, infant mortality, that is easily comparable with any other country around us, except maybe Singapore, and maybe if we compare maternal mortality, we still have room for improvement. Afterall, we only spend about 3.6% of our GDP on healthcare. A very small amount by any standards, to get the outcome that we are getting.
I also learn that in the Pharmaceutical Division procurement and drug delivery services, as we observe from Yr 2006 to Yr 2008, it took longer to get drugs out to depot centers in West Malaysia. In S'wak, over time, it took less time from 2006-2008. I could not understand that. How come with improvement in the country's transport system, it was taking longer, so that the drug depot centers, would run out of drugs., including essential ones.
All in all, there looks like a great paucity of data on healhcare and healthcare delivery, in the country. Many a time, we are just using logical thinking, following patterns from other countries, WHO advice ( experience from first world countries ) and a strong dose of " gut feeling " ( read how the people in charge feels ). Our drive to gather information and data, before making important strategic decision is still greatly lacking.
We went to the workshop with 2 important messages. Firstly, involve more private doctors in the discussions as they are one third the stakeholders in the drug policies ( namely the pharmas, the doctors and the patients ). The room was filled with pharmas and administrators and only three doctors. The second clear message is, why try and fix something which ain't broken? We are spending 3.6% of our GDP on healthcare ( a small amount by first world standards ) and getting good outcomes, and we are spending 11.7% of our healthcare budget on medicines, which is again a very reasonable amount by any standards, to get the outcomes that we are getting. We are getting value for money.
Anyway, the three of us felt, after the sessions, that whatever was being discussed, was already very much decided and awaiting implementation. Looks like the authorities, have decided that there must be generic substitution ( something we wrote on earlier ) and they will implement a separation of prescribing and dispensing, come what may, whether is good for healthcare in Malaysia or not. Whether we are spending our healthcare budget wisely or not.
But then this is Malaysia. Looks like they will do whatever they wish, and why should healthcare be any different.