No medicine for poorest Pinoys
(From Manila Times, Tuesday, 09 March 2010)
THE banner of the Inquirer on Monday “More Pinoys poor, GMA adviser
admits” did not surprise anyone.
For the fact reiterated in the
banner is known to most Filipinos.
It is personally known especially by those
who make up more than 50 percent of the population who live below, on
and just barely above the poverty line, and even those who used to
belong to the shrinking middle class and have become poor but are still
maintaining, painfully, their better-than-poverty-stricken lifestyle.
It
was also not a surprise that the statement that gave the banner a bite
had come from Gov. Jose Salceda of Albay. Salceda is he who had said of
the President, in connection with the streak of economic expansion that
makes banks and international agencies respect the Arroyo
administration, that she is “one lucky bitch.”
Salceda said,
according to the Inquirer, that his biggest frustration was seeing that
the 34 quarters of uninterrupted economic growth in the nine years that
Mrs. Gloria Macapagal Arroyo has been president “did little to reduce
poverty and the number of poor people.”
New medicine
policy not helping poor
Newly released findings of an
Asian Institute of Management center confirms the depth of poverty in
our country in respect to poor people and the medicine they need but
cannot afford to have.
The study finds that the newly introduced
medicines policy—just like the Gross Domestic Product growth or economic
expansion the Philippines (or rather the Filipino rich) has enjoyed
these past nine years—has not benefited the poor of our country.
The
Center for Legislative Development (CLD), an independent policy
research center, finds that the latest government drug policy that sets
price ceilings on some essential medicines has been ineffective.
The new cheaper medicines law and policy have failed to improve the
poor’s access to medicine. Why? Simply because the sick who are poor
don’t have money to buy these medicines even at the current reduced
prices.
The study involved surveys in known poor barangays in
Manila, Caloocan and Quezon City. It found that even with the
substantial reduction in prices of medicines, the poor still find it
difficult to buy the number and quality of drugs they need to cure or
control their illnesses.
The survey was done a month after the
initial implementation of the Access to Cheaper and Quality Medicines
Law.
Most respondents in the surveys reported that they only
sporadically or even rarely purchased maintenance drugs prescribed by
their physicians. A key finding in the study confirmed that access to
medical care, i.e., the availability of a doctor, is a key factor in
determining access to medicine.
Without regular consultations,
respondents resorted to relying on other sources for information such as
drugstore clerks, neighbors or relatives, to determine their medicine
purchases. Physicians warn that consumption of prescription medicines
should be under the supervision of a qualified medical practitioner.
This
is because the most common illnesses—such as hypertension, diabetes,
and arthritis—are long-term, chronic illnesses. Irregular consumption or
consumption of the wrong medicines means most of these poor patients
are in fact putting their lives at greater risk.
The study
concludes that the Filipino poor are so poor that price cuts would not
result in their greater access to medicines and that the policy to
mediate access to medicines through pricing intervention would benefit
mainly middle-class poeple who already have access to medicines.
Prof.
Emmanuel Leyco, CLD’s Executive Director who specializes on health care
financing, reiterated a conclusion found in many earlier studies: “If
the government wishes to reach the poorest sector, it may have to
explore other means, like adopting a drug subsidy program for the poor,
financed and administered by the national health insurance program.“
Prof.
Leyco said the current price reduction policy could only result in
broader access by the poor if it is combined with a drug procurement
program by government that targets priority diseases and population
segments in known poor geographical areas.
The poor are too poor, price cuts do not result in greater access to medicines
A recurring policy theme that the government has adopted towards this goal focused on the prices of medicines that many considered were beyond the reach of the poor majority. Towards this end, the government has, by way of legislation and executive orders, sought to bring medicines, especially those used to cure or control the most common diseases, within the reach of even the poorest households. Among the measures that have been adopted was the Generic Drugs Law that mandated the use of generic names in prescribing, labeling and marketing of drugs to give consumers more choices and discretion in their purchase of drugs, other than relying on more expensive “branded” drugs. Recently, the government took more unprecedented steps to bring down the price of the most essential drugs. These included the importation of cheaper medicines from neighboring countries, the establishment of small neighborhood pharmacies selling medicines at subsidized prices, and the outright imposition of a price ceiling on medicines most in demand.
The expectation is that, with the prices of the most essential medicines brought down to at least half of their previous cost, the Filipino people, but especially those living below the poverty line, would have greater access to the medicines they need to maintain their health.
To examine its impact, CLD's Health Policy Network surveyed the residents of six barangays in three cities in Metro Manila: Manila City, Caloocan and Quezon City. While the samples were too small to stand for the national population, the findings of the survey do give a picture of the health behavior of the poorest sector, and their attitudes towards seeking to cure or control their illnesses.
A major finding is that, even with the price ceiling on medicines lowered considerably, the poor still find it difficult to buy the number and quality of drugs they need to cure or control their illnesses. Most of the respondents reported sporadic or even rare consumption of medicines. Another finding is that access to medical care, i.e., the availability of a doctor, is a key factor in determining access to medicine. Without regular consultations, respondents reported relying on other sources for information such as drugstore clerks, neighbors or relatives, to determine their medicine purchases. Since the most common illnesses, such as hypertension, diabetes, and arthritis are long-term, chronic illnesses, irregular consumption or consumption of the wrong medicines means most of them are in fact putting their lives at greater risk.
The study concludes that the Filipino poor are so poor that price cuts would not result in greater access to medicines and that the policy to mediate access to medicines through pricing intervention would benefit mainly the middle-class who already have access to medicines. If the government wishes to reach the poorest sector, it may have to explore other means, like adopting a drug subsidy program for the poor, financed and administered by the national health insurance program.
HPN study finds Philippine healthcare financing system seriously underfunded, inequitable
Despite recent policy moves that seek to address such inequities, the poor remain vulnerable and questions remain whether they will be actually benefited with increased access or merely reinforce the access of those who already enjoy them.
Over 15 years since Congress passed the National Health Insurance Act of 1995, inequities pervade notwithstanding the over all improvement in health outcomes. The Act established the National Health Insurance Program (NHIP) and created the Philippine Health Insurance Corporation (PhilHealth) as its financing vehicle with a clear constitutional mandate that “the State shall adopt an integrated and comprehensive approach to health development which shall endeavour to make essential goods, health and other social services available to all the people at affordable costs.”
The NHIP has set2015 as goal for providing coverage for all Filipinos as mandated by the law. Just a few more years before its goal,studies suggest that a vast majority of Filipinos still remain inadequately covered by the national health insurance program.
The CLD-HPN study is available at CLD's website: http: cld.org
Quality issues in delivery of health care services: A policy perspective
Depending on one's ability to pay, Filipino patients may enjoy the best state-of-the-art care that is comparable to the best there is in highly advanced countries. But a much larger portion of the population has to do with improvised health care technology like the fabled makeshift incubators used by cash-strapped health care facilities in remote health care facilities.
How do we ensure that policy initiatives address health care inequities rather than perpetuate them? How do we distinguish policies that were pushed in the name of the poor but does very little for them?
To explore these issues, we would like to invite you to a policy discussion on "Quality issues in delivery of health care services: A Policy perspective on May 27, 2009, Wednesday, 9 am to 11 am at the AIM Conference Center, Benavidez corner Trasierra Streets Legazpi Village Makati City.
To reserve a seat for the forum, please call Netsky at 750-1010 local 2072 or email us at healthpolicy@cld.org.