"Why is the cost of medicine in the Philippines so high?"
(Towards a Revolutionary Health System)
By Edberto Villegas
By Edberto Villegas
It is about time that a survey be conducted to determine how many Filipinos die each year from curable diseases which could have been prevented if they could have only afforded the prices of medicines for these ailments. Such a survey has long been awaited because in the Philippines the costs of medicines are 40 to 70% higher compared to other Asean countries. This is attested by the results of a study of the Health Action International (HAI) where it is shown that the Philippines was paying 18 times and 7 times the standard international prices for branded medicines and the lowest priced generic medicines, respectively, in 2005. From another study by WHO/HAI in 2008 of 36 randomly selected low-income and middle-income countries, the Philippines paid the highest prices for the lowest priced generic medicines compared to the standard international prices for 15 core and commonly-used medicines. For branded medicines, as a case in point, among this basket of 15 medicines, the country paid the second highest price at 6 times higher than the standard international price , after only Morocco (9.4 times higher), for the capsule ciprofloxacin. It is also shown in the latter study that the availability from the Philippine government of generic medicines was the lowest among countries in the Western Pacific region at 22.2% lower compared to the average availability of publicly-acquired generic medicines in the 36 countries surveyed. Generic availability from private outlets, drug stores, private hospitals, etc. was likewise low at 33.6% of the average availability for all the other countries.(from Medicine prices, availability and affordability in 36 developing and middle-income countries, The Lancet, 2008 and A Survey of Medicine Prices and Availability in the Philippines, HAI network, 2009)
A main reason for these high prices is the utter lack of regulations of medicine prices in the Philippines based on its neo-liberal policies of deregulation, privatization and liberalization imposed by the World Bank starting in the late 1980's for its client middle-income and developing countries. Coupled with the fact that the drug industry in the country is dominated by the big foreign pharmaceutical multinational companies like Pfizer, Wyeth, Sanofi-Aventis, Abbot and Glaxosmith.line and the corruption-infested Department of Health(with its latest dengvaxia scandal with Sanofi-Aventis), Juan de la Cruz has just to wait for death when the medicine for his salvation is so exorbitantly priced beyond the reach of his meagre wage or even his salary. Imagine just how many Filipinos have died this way.It is to be noted that the Philippines spent in 2014 a measly 4.7% for health services as a proportion of its GDP when the global average of health expenditures to GDP is 9.5%. Compare this to Vietnam at 7% to GDP for the same year. That is why life expectancy, considered by the UN as a measure of the quality of health of a people, is 69 years in tn the Philippines, among the lowest in Asia, except for Burma(68 years), Laos(64 years) and Cambodia(65 years). (World Fact Book, 2017) So much for the formerly American-vaunted most advanced health services in Southeast Asia with the headquarters of WHO in the Western Pacific region even set up yet in Manila.
The only solution to the dire state of affairs of health services in the Philippines is to overhaul entirely its socio-political system. Reforms of the health system have not worked at all with such attempts like the Philhealth and the program of doctors to the barrio of former Secretary of Health Juan Flavier. The Philhealth has also descended into the mire of endemic corruption in the Philippine bureaucracy and the doctors to the barrio program was just like a prairie fire that was soon gone. Philippine doctors and nurses would rather go abroad, seeking greener pastures, than work in far-flung places in the Philippines. It is to be noted that in the Philippines there is only 1 doctor per 1000 people compared to Cuba, for instance, with 6 doctors/1000.(from Nationmaster)
The health system in Cuba could serve as a model for the Philippines to emulate after the overhauling by the latter of its present socio-political system. After its revolution in 1959, Cuba introduced its polyclinics with 20 to 40 doctor and nurse offices in each polyclinic-teaching center for the training of nursing and other medical workers, currently serving 95 percent of its population reaching remote places in the mountains and isolated coastal regions of its 15 provinces and its municipality, "Isla de la Juventud". A polyclinic functions both as a preventive and curative medical unit, adjusted to the particular needs of a place, for instance, to confront the prevalent diseases in the area, to educate particularly along medical knowledge the peculiar groups in the area, etc. A testimony to the effective health system in Cuba is that life expectancy in this country increased from 58 years in 1959 to 79 years in 2015. Health care is upheld in Article 50 of the Cuban constitution as a right and not as a privilege and therefore is universal and free, including the costs of medicines. The Cuban government considers it as a moral duty for its health workers to serve the masses, specially the poor(rejecting the liberal philosophy of individualism), following the principles enunciated by Ernesto "Che" Guevara in his speech "Revolutionary Medicine". Guevara was a leading revolutionary leader, only next to Fidel Castro, in the Cuban revolution and a medical doctor. In fact, it was primarily through the initiatives of Che that extensive rural medical service was implemented in Cuba and medical students are required to specialize in family medicine for two years before they can go into other specializations. Cuba has been cited by the WHO as most advanced in the line of health system finance in Lain America and even ahead of the US in this field. Cuba spends 10.5% for health expenditures as part of its GDP. It has pioneered in the discovery of new medicines, e.g., creating the first and only vaccine against meningitis B, first to eliminate the transmission of HIV and syphilis from mother to child and other cures. Its medical volunteer program has sent 300,000 volunteer doctors and nurses at the expense of the Cuban government to 158 countries since 1960, also along Che's concept that freedom must also be based on social responsibility not only to your own people but for suffering humanity in general.(from Haley Wiebel, Research Institute at the Council of Hemispheric Affairs) Unfortunately, Che was killed by the US CIA in Bolivia in 1967 at the age of 39 when he helped organize a socialist revolution in that country.
The Philippines can develop its own health industry, as advocated by the progressive Health Alliance for Democracy(HEAD) of the Philippine, what with the country's abundant medicinal plants (if compared to Cuba) and its own very competent medical workers, most of whom, however, prefer to work abroad. But first it needs to nationalize the health industry after a social revolution and craft a new constitution, incorporating an article in this document upholding medical care as a right of the people and to be universal and free. Our medical workers must finally truly abide by the Hippocratic oath that succoring to the needs of the sick is a human responsibility and fervently love the poor masses as Commandante Dr. Ernesto "Che" Guevara did in his short but meaningful life.
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Note: My diseased father, Dr. Jose A. Villegas, was a government rural doctor. He was assigned to several provinces, Mindoro, Palawan, Quezon, Cagayan, Isabela and Negros Oriental. When I was a young boy, at times he took me along in his barrio visits.. He was truly incorruptible. One time, he shouted all over the place in our home at two individuals who were instructed to deliver the latest long stereo phonographic player cum radio, a luxury at that time, for my father, who was now an undersecretary of health. He was truly mad, castigating the drug company who tried to bribe him for some favors and telling the delivery duo to return the stereo pronto to the sender. He died disappointed with the Department of Health, but he performed his duties with dedication and love for the poor.. He wanted me to follow in his path but the First Quarter Storm had other plans for me. This article is for my father.
(Edberto Villegas is a retired University of the Philippines-Manila professor of development studies and political economy. A Descendant of General Miguel Malvar and a former political prisoner during the Marcos regime, He has authored several books and essays in his field of expertise and also written some literary works on the side.)