The media debate on the ‘doctors prescribe, pharmacists dispense’ (DPPD) issue is getting hotter as both parties have forwarded their favourable points and information for the attention of the general public. There are many advantages in upholding the status quo as it has worked to the nation’s benefit, especially for the lower income groups. There is no need to imitate other countries with different systems.
I have listed a number of points that favour the continuation of the present system:
1. Doing away with the present practice will lead to more patients heading to the already overcrowded and under-staffed government hospitals where consultation and medication are almost free. The main drawbacks of delay and waiting time in government hospitals will pale into insignificance if the DPPD system is imposed.
Patients would rather go to the government clinics or hospitals as the inconvenience of consulting a private general practitioner first and then heading to the pharmacy will be unattractive to the public. The government can expect a larger number of patients using its healthcare services in preferences to private clinics. Both private doctors and pharmacies will lose out in this scenario.
2. One often observes in Bollywood movies situations about a family doctor attending to his critically-ill patient and issuing a prescription for certain medicines. By the time the medicine arrives the patient has already died. This is a poignant reference to draw attention of the present patient-friendly practice and stop tampering with it.
In the rural and suburban areas where there may be 24-hour clinics but no night-time pharmacies or nearby hospitals, it can have serious consequences for the patients.
3. The cost of healthcare could go up and more so when the goods and services tax (GST) is imposed as consultation and medication are mostly not GST-exempted. It is well known the prices of medicines in Malaysia are some of the highest in the world. There is nothing cheap in the pharmacies.
Unlike doctors who will provide ‘loose’ amounts for the patients’ needs, pharmacies sell medicines in one bottle, box, strip, tube etc. and ‘loose’ amounts are mostly not available.
4. Presently doctors, despite many being money-minded, are still reported as professionals doing a community service, unlike pharmacies which are looked upon as a business undertaking. We
already have a situation where private hospitals and their doctors and specialists are no longer generally held in favour due to their exorbitant charges and fees.
5. The image of doctors will suffer if they have to charge more for consultation to make up for the shortfall due to loss of dispensing rights. Allowing only pharmacies to dispense medicine will
make healthcare an even more money making proposition that will dent the image of the government, especially when affordable healthcare is a duty of the government to the people.
6. Medical specialists will add more complexity to this issue. As is well-known, specialist treatment needs a different range of medicines and drugs which is not needed by the general public.
Will the pharmacies stock these costly medicines knowing well there is only a limited clientele for them? Will it not be discriminatory if doctors cannot dispense but specialists are able to?
Healthcare has no substitute
7. Pharmacists can form a cartel-like country-wide set up just like the telcos who are notorious for keeping their charges high despite the so-called ‘competition’. Like food, healthcare has no
substitute - one has to eat or buy medicines no matter what the cost.
8. Alternative medicines will become more popular as they are cheaper despite risks and problems. Self-medicating too could be opted for by more people, thereby providing more business to pharmacies. As it is private clinics and pharmacies are mostly doing well, depending on the location, as revealed by their greater numbers.
A large number of Malaysians are employed by clinics and some thought should be given to them. They are mostly educated to the Form 3-5 level and will find it difficult to get reasonably paying jobs. There may not be a corresponding increase in the number of employees in the pharmacies.
9. The present system is good and changes should be avoided until such a time when increased levels of the middle class and the lower income group have increased to an extent where there will not be complaints.
