Dr. Anita Wagner presented a paper on Universal Coverage or Universal HealthCare (UHC) as used here in the Philippines or other countries. The three questions on expanding healthcare coverage are: (a) extend to non-contributors to the fund, the very poor? (b) expand HC services? and (c) reduce cost and mandatory fees?
I believe in UHC, that everyone, from the poor to the rich, young and old, should have one form of health insurance that can cover both outpatient and hospitalization services. But I do not believe that it is only the government, or mainly the government, that should provide such service. I believe there is a big role for both corporate and civil society provision of healthcare at various levels: community or village, work place and offices, schools and universities. Just give the people various options and choices where and what kind of HC coverage at different price packages would satisfy their personal and household needs.
The medicines aspect of HC. The share of the "pharmerging" (emerging and industrializing economies' consumption of pharmaceutical products) markets to global medicines spending is rising, from only 14 percent of total world demand in 2006, to 20 percent last year, and projected to grow to 30 percent by 2016.
Table below shows that almost 30 percent of total HC spending in low-income countries goes to medicines alone, and only 18.2 percent for high incomes ones.
I think the main reason why the poor has a high percentage of their household healthcare spending that goes to medicines is because they have no health insurance for outpatient services other than those offered by the nearby government clinic or hospital. For instance, when they have a headache or prolonged fever or bad stomach, among the first things they do is to buy medicines that they see are heavily advertised in tv, radio, billboards and newspapers or magazines. Or those that are recommended by their neighbors, family members and friends. They do not go to private clinics and physicians because physician consultation fee alone would be about the equivalent to one or two-day/s work. And if the physician would order a diagnostic test, the cost would soar further. So the solution is not to see a doctor and just self-medicate. So spending for professional fee and for diagnostic test/s is zero or near zero, the denominator is low, and that raises the share of medicines (the numerator) to total household health spending.
Below, the same story, that spending for medicines dominate the total household healthcare spending. And I offer the same explanation above why this is so. Low chart, same medicines, different cost. Naturally. Why?
The same way that the price of soda (Coke or Pepsi, etc.) would vary from an ordinary variety (or "sari-sari") store to convenience store to a cheap restaurant to a fine dining resto to a hotel. A bottle of an 8 oz soda for instance can range from P8 to P70 depending on where one would buy the soft drink.
The price of medicines for the same molecule, same dosage, from the same manufacturer, can vary from one drugstore or pharmacy to another. A drugstore in a low-rental place, no air-conditioner, no licensed pharmacist, not paying multiple taxes, can sell medicines at very low price. A drugstore or pharmacy in a high-end mall, fully air-conditioned, has several licensed pharmacists, and complies with various/multiple taxes and regulatory fees, will have to pass on those costs to the price of their medicines. Hospitals will have additional costs to charge when they dispense medicines to their confined patients.
