Magic potions and medicine men

The Department of Health (DOH) recently announced a radical price cut of 50% or more on 124 kinds of medicines, as well as certain procedures related to renal disease and cancer treatments. Normally, people would be saying WOW! But that did not happen; in fact the media gave it a mere one-day mention in the news. The press release of the DOH was clearly written in a very strategic and tactical manner in order to draw public support as well as neutralize any adverse reactions from drug manufacturers. To the uninformed, it sounded or read like the DOH did its homework, made price comparisons and wanted a just and fair way of cutting prices. The announcement even invoked the name of President Duterte in such a way that he would either get credit for it or get bashed depending on how he handles the selection and imposition of the second or third round of MRP / Maximum Retail Price pronouncements as provided for in the Cheaper Medicines Law.

So why did the latest MRP announcement fail to get traction or draw public appreciation? Perhaps the first and biggest mistake was not to include the names of the 120 medicines/ products and procedures that the DOH was referring to. The 56 discount for nothing means nothing to me. Any normal reader would immediately have gone to the list of products to find out if he or she would benefit from the latest MRP list, but there was none. More than “bitin” the pronouncement was a waste of time because the story did not have an ending. Aside from not naming names or giving a list, the DOH announcement presented their action like lawyers focusing too much on their argument or justification for the MRP by claiming that the prices of medicines were so high, even for generic medicines, some of which they claim were 4 times higher in the Philippines than in any other country. As a consumer, I was more interested in knowing if my maintenance medicines were covered – period.

So why didn’t the DOH present the list to the public, opting instead to give “the” list to President Duterte later? Is it in the interest of giving the President a gift of sorts, bragging rights perhaps for being able to impose a market shaking price reduction? A DOH official claims that only President Duterte has the power to impose the MRP or price reduction as provided for in the Cheaper Medicines Law, while the DOH can only recommend the action. That however does not prevent the DOH from showing the public what’s on the list? I also wonder why was the announcement done while Secretary Francisco Duque was busy making a presentation on the Universal Health Care program before the UN in New York City? One would presume that the head of the department should have been given the honor or right to make such a high impact pronouncement that could have waited a week until the Secretary’s return. 

Is it because certain people behind the MRP list expect a major backlash from the pharmaceutical companies, some of whom are fuming mad with what they call a railroading of the principles of consultation and due process? Word is that the group behind the MRP ignored and refused to meet with medicine manufacturers exclusively even after numerous letters and requests? Instead, the DOH representatives insisted on a multi-sectoral public consultation so that critics of the DOH can’t accuse them of “Being in bed with Pharma companies”. No one can blame DOH officials for being paranoid especially after the bashing they received from the Anti-Dengvaxia community, but such unfortunate circumstance does not merit correcting one wrong with another wrong.  President Duterte should carefully inquire just how fair and how well did the DOH go about engaging stakeholders because if there were no genuine consultations, dragging the President into what promises to be a controversial and legally explosive situation could embarrass and implicate the President in something he is presently unaware of.

Going back to the topic on why the DOH MRP was a dud, it is highly possible that people also have a much bigger concern than the price of medicines. John, a security guard I know, recently had a severe case of chest pains and throbbing on the back of his neck. In spite of six kids and an uncle imploring him to go to the local hospital, he refused. He chose to self medicate and rest. He is representative of millions of Filipinos who refuse to go to a hospital except under extreme pain or when they are unconscious and brought by relatives. They are 100% convinced that they cannot afford hospitals. Some LGU hospitals require that you show your voters ID before admission, and except in emergency cases, you are required to give a deposit. That is the more immediate problem of Filipinos. They are ignorant about PhilHealth benefits, they are more frightened with costs than death, and they have no proper appreciation or understanding of our health care system.

The DOH and government should first focus on the need for early consultation, bringing down the high cost of procedures and laboratory examinations etc. I heard about a hospital administrator who explained how he brought a major hospital from bankruptcy to profit “by making it a policy that patients undergo a barrage of examinations during the first 24 or 48 hours of admission. That is when the hospital makes the biggest profit margin, after that the hospital is nothing more than an inexpensive hotel”.

The heart of the DOH officials are in the right place but as far as patients and Universal Health Care go, what we need are more hospitals, better information and implementation of PhilHealth privileges, less expensive laboratory tests and procedures, and integrity in the treatment options given to doctors not just cheaper medicines.

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