Showing posts with label Melissa Guerrero. Show all posts
Showing posts with label Melissa Guerrero. Show all posts

Tuesday, February 11, 2014

MeTA 16: Day 1 of Conference 2014

The 2014 Medicines Transparency Alliance (MeTA) Philippines forum 2014 started today, here at the Bayanihan Center of Unilab Complex, Pasig City, Metro Manila. Attendance is big, 100+ people attending. I see many new faces here compared to past MeTA PH fora.

Below, they key speakers, from left: Former Bulacan Gov. Roberto "Obet" Pagdanganan, MeTA Philippines Chairman, gave the Opening Remarks. Dr. Tim Reed, Health Action International (HAI, Amsterdam, the International MeTA Secretariat). Dr. Deirdre Dimancesco of WHO in Geneva, and Dr. Francisco Tranquilino of the UP College of Medicine, also Chairman of the Ethics Committee, Philippine College of Physicians (PCP). He gave the Keynote Speech. 

In his brief speech, Dr. Tim Reed noted that "Multistakeholder engagement is clearly achieved in this forum" as the participants come from different sectors and agencies -- government, corporate and industry players, and civil society organization. 


Dr. Art Catli of the Pharmaceutical and Healthcare Association of the Philippines (PHAP) introduced Dr. Tranquilino. Said that the latter is a very popular, well-sought speaker, giving countless speeches here and abroad; that he is a "terror" teacher at UP; a workshorse, a researcher who has published dozens of academic articles, an ambassador of good will. 

Dr. Tranquilino disclosed his past and present engagement in the pharma industry, most of which were with the innovator companies. He started discussing "striking a balance" between innovation and government regulations. 

Medicines save lives, but developing new medicines now take 11-15 years out of 20 years total patent period. Many compounds that were originally discovered and were patented do NOT become medicines, if they do not pass the various clinical trials for safety, efficacy and other criteria. In the last decade, there was dying of pipelines of new revolutionary drugs, resulting in more mergers and consolidation of big pharma companies.  

The Mexico City Principles (MCP) for voluntary codes of ethics of businesses especially in biopharmaceutical sector was adopted by APEC member countries to help reduce corruption, bribery, and at the same time protect public health. 



The next session was on “Multistakeholder advocacy for adherence to the MCP”. The speakers were, from left: Tomas Marcelo "Beau" Agana, Past President of the Philippine Chamber of Pharmaceutical Industry (PCPI), the federation of domestic or national pharma manufacturers and drugstores; Teodoro "Ted" Padilla, Executive Director of PHAP; Atty. Florina Agtarap of the Department of Justice (DOJ) Office of Competition; Dr. C. Diza of the Food and Drugs Administration (FDA); and Dr. Melissa Guerrero of DOH National Center for Pharmaceutical Access and Management (NCPAM). Moderator was Yolanda Ibarle, MeTA Project Director.

Dr. Guerrero said that there are ethical issues in government processes, they have to address those upfront. She hopes that MeTA Philippines and its multi-stakeholder partners can help the DOH urge the local government units (LGUs) abide by DOH rules on the selection of suppliers, truthful procurement of medicines.


Dr. Diza said that FDA will hopefully develop guidelines or an Administrative Order (AO) specifying what needs to be followed from the MCP.

Beau Agana of PCPI talked about their draft Code of Ethics, an APEC workshop for voluntary code of ethics in 2012. Relationship building becomes problematic in pharmaceutical marketing under information asymmetry condition, he said. Code of Ethics will temper maximizing personal interest of doctors and other 3rd party decision makers, and prioritize patients' interests. He added that  patients have started to turn to pharmacists, not their doctors, in their medicines purchase. 


Ted Padilla of PHAP said that they have their Code of Ethics early, that penalties are imposed on  violating member firms and personel. Monetary sanction, a fine, is more effective in tightening behavior. Transparency is essential, there is no substitute to being transparent and honest, and medical decisions must always be made with the best interest of the patients, he added.

During the open forum, some concerns were raised regarding the procurement process and practices of LGUs, not only of medicines but also medical supplies, equipment and facilities.

My main concern in being involved in topics like this is how civil society and voluntary organizations will have greater role in promoting transparency and competition in the economy. Very often, self-regulation by industry players themselves are better than government regulations, restrictions and politics. Manufacturers, wholesalers and retailers who sell only good quality products because they have concern for their customers, or because they are scared that they will be scandalized if their products are discovered to be unsafe and/or ineffective. 
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See also:
Health Transparency 12: MeTA Philippines Dynamism, October 02, 2012 
Health Transparency 13: MeTA International Visit to Manila, April 16, 2013 

Health Transparency 14: IMS-CHAT Meeting, April 18, 2013, Friday, July 12, 2013 

MeTA 15: Forum 2014 on Healthcare Ethics and Transparency, January 30, 2014

Saturday, June 29, 2013

Drug Price Control 35: DOH Procurement Price and Lobbying for Another Price Coercion

Government price control is price dictatorship. It is wrong, messy and ugly.
Explore new data below, 2,500+ words, nine pages long including seven tables and one graph, get your favorite drinks and enjoy the ride.

Price comparison across countries of certain goods and services is useful both for public and private decision making, provided that people are using the appropriate and verifiable conversion factors. Otherwise, the comparison can only lead to confusion, not education, and can lead to wrong public policy formulation.

After my reply to the email of James Auste, head of the Cancer Warriors Foundation (CWF), to all members of the DOH Advisory Council on the Implementation of RA 9502 (Cheaper Medicines Law of 2008), see Drug Price Control 32: Policeman of Pharma Companies, Dr. Melissa Guerrero of NCPAM-DOH iinformed me that prices of anti-cancer drugs in the Philippines remain expensive and out of reach of many Filipinos and offered to show the data. I was happy for her offer, and after several emails, she sent me the data. Posting these with her permission, as they plan to post this also in the DOH website, for transparency purposes. Thanks a lot for the data, Doc Melissa.

Tables 1 to 4. DOH Purchase Price Index (PPI), Selected Medicines, 2009-2013, in Pesos


Of the 10 drugs shown above, there is a notable increase in the PPI from 2009-2010 for all except #s 2, 3 and 10. No price change from 2010 to 2012 for all except #7 (increase) and #10 (decrease). Then a declin in prices from 2012 to 2013 for all except #8. The change in prices were mainly due to the change in the name of supplier or trader.

Here are the other 11 drugs.


Price movement from 2009-2010, increase except #s 13, 14,16,  18, 20, 21, which retained their prices or declined (#16). From 2010-2012, prices have generally remained the same except #s 11 and 12 which declined. And from 2012-2013, price declines except # 16 (same price) and 18 (increased).

Before I show the price comparison of the above medicines among the Philippines, Thailand and India, I warned readers in my previous article that there is No Single National Price for most if not all commodities like medicines in a particular country. There are many sellers catering to particular customers and buyers and thus, have different prices for the same product made by the same manufacturer.

Consider these two graphs below for a particular medicine. Equilibrium points (where supply meets or intersects demand) A and B are prices in the pharmacies of the high end hospitals in Metro Manila like Makati Med and St. Lukes; C and D are prices for cheaper hospitals; E and F are prices for the big drugstores like Mercury and Rose or Watsons, G and H are for The Generics, Generika, and points I, J, K and so on are prices of the smaller drugstores.

Thus, one can make a table of price differences not only between the Philippines and Country B or Country C, but also among different drug outlets and retailers within the Philippines. There is NO national price for a particular commodity in one country. Only the price of the biggest retailer or second or third biggest retailer, as proxy or estimate of the prevailing price in a country at a given point in time.


So for inter-country price comparison to become meaningful and verifiable, I suggested that  one 
must show, or at least consider and mention the following:

(a) same or comparable retail outlet, say only from Watsons;
(b) same reference period, say June 15, 2013;
(c) exchange rate used for converting different currencies into a common currency on a particular day, say as of June 15, 2013;
(d) taxes and fees, national and local, applied on medicines;
(e) subsidies or mandatory discount, if any, applied on medicines;
(f) other factors.

When those verifiable factors are not shown or even considered, then the price comparison becomes less effective as the readers would only blame the country with the higher price, especially the drug manufacturers and/or drugstores.

It is possible that drug manufacturers and pharmacies in country A would have higher profit margin than those in countries B and C, even if they have lower retail prices than their counterparts in B and C.

How? When the government in country A (a) does not impose taxes on medicines, (b) has lower corporate income tax and other business taxes than in countries B and C, (c) directly subsidizes a particular medicine so that it can be sold at a lower price, (d) other factors.

With that caution, here now are the price comparison for the Philippines, Thailand and India, for the 21 medicines purchased by the DOH. The current market price for the Philippines referred here is the price of Mercury Drugstore (it corners about 60 percent of the total retail pharma market in the Philippines) and an undisclosed "big private hospital". 

Saturday, December 31, 2011

Healthcare Competition 8: Centralization vs. Deregulation of Healthcare

Last December 5, I posted my paper on Taiwan's National Health Insurance (NHI) system in a facebook group, Pharma Cares. It has attracted a brief exchange of ideas with Dr. Melissa S. Guerrero, the former Director of NCPAM (National Center for Pharmaceutical Access and Management) - DOH. I did not have time to re-read the papers that she posted, but I think readers of this article would benefit from those links that Doc Melissa gave.

I only asked permission from her to post our exchange in CHAT googlegroups, the online discussion group of  Coalition for Health Advocacy and Transparency, which I did. I thought readers of this blog would be happy to check the various papers and studies that she suggested, so I decided to post the exchange in this blog as well.

  • Hi all, may I share with you some facts and opinion about Taiwan's National Health Insurance (NHI), and how these can be considered in the proposed revisions to PhilHealth and "universal healthcare", http://funwithgovernment.blogspot.com/2011/12/healthcare-competition-13-taiwans-nhi.html



    • Mhyanne Panganiban-Dioso ang dami po senate bills proposing ammendments sa PHIC..
      December 14 at 10:04pm · 

    • Nonoy Oplas Meron din bang bills deregulating the health insurance sector? I think all bills are for further centralization of the sector, and that's where many problems come, like in the case of Taiwan.
      December 15 at 6:05am · 

    • Melissa Guerrero There are many success stories too of centralized healthcare with strong government financing and regulations--- Germany, UK, Netherlands, Australia. Meanwhile, deregulating the health insurance sector is like going to the direction of the USA which is the most inefficient, wasteful and inequitable system which Obama now finds difficult to dislodge given the lobbying of the for-profit HMO industry. We don't really wanna go there.
      December 19 at 4:07am · 

    • Nonoy Oplas But I read that UK system is inefficient too, here are the 5 scary stories, http://funwithgovernment.blogspot.com/2011/02/healhcare-competition-8-uk-again.html. In addition, it's bleeding financially, like what's happening in Canada, Taiwan, etc.

      December 19 at 6:51am ·  · 

    • Melissa Guerrero There is no perfect system. In fact from here I can see that there are still inefficiencies they can do without (they're funding bariatric surgery for example). But it is backed up by evidence that the UK NHS is the most efficient and compared to the US has far better health outcomes given that it spends half than the US does. US on the other hand, has the biggest health spending, has the most uninsured, and the worse child health outcomes among developed countries.http://image.guardian.co.uk/sys-files/Guardian/documents/2011/08/07/JRSMpaperPritWall.pdf
      December 19 at 7:52am · 

    • Nonoy Oplas Thanks for that study doc melissa. I think the authors failed to mention that the main reason why healthcare in the US is very expensive is because of their litigious and medical malpractice system. A physician normally pays $250,000 insurance per year, protection against suing by patients between now and up to 18 yrs in the future (in the case of OB Gyne specialists). So physicians will jack up their fees to recover that quarter million investment in insurance alone.
      December 19 at 7:59am · 

    • Melissa Guerrero The point is why would we choose a system which doesn't work? Even US citizens are complaining and jumping to canada borders to get affordable medicines. My American health economist friend complains his system doesn't work. Everyone in the Western world is asking the US: "then why are you letting drug companies make your system go bust?"
      December 19 at 8:03am · 

    • Melissa Guerrero Well there are the litigations but they are also known to have the highest prices of medicines like the Philippines. Too much specialization, no gatekeeping, laiseez faire health market (that doesn't work and is in fact dangerous in health economics, that's why there's a separate science).
      December 19 at 8:05am · 

    • Nonoy Oplas The news report and Pritchard paper mentioned Switzerland as having an inefficient health system. That's the opposite from a news report that I read and discussed here, http://funwithgovernment.blogspot.com/2010/08/healthcare-competition-1-switzerland.html. Swiss people are required to have a health insurance, but they are not required to get from only one supplier, the govt. There is competition, people have choices.

      December 19 at 8:08am ·  · 

    • Melissa Guerrero Why does US health care cost so much?http://economix.blogs.nytimes.com/2008/11/14/why-does-us-health-care-cost-so-much-part-i/
      December 19 at 8:12am · 

    • Melissa Guerrero ‎"The myth that competition has been key to cost containment in the Netherlands has obscured a crucial reality. Health care systems in Europe, Canada, Japan, and beyond, all of which spend much less than the United States on medical services, rely on regulation of prices, coordinated payment, budgets, and in some cases limits on selected expensive medical technologies, to contain health care spending.5 Systemwide regulation of spending, rather than competition among insurers, is the key to controlling health care costs."http://www.nejm.org/doi/full/10.1056/NEJMp1106090
      December 19 at 8:31am · 

    • Nonoy Oplas Thanks for the links, I will chew them and make a discussion paper later. But Japan is constantly mentioned in the papers you gave. My friend who lives in Japan says the healthcare system there is heavily indebted, close to bankruptcy. The Japan govt shoulders 95% of hospitalization bill, so physicians over-charge, they don't prescribe generics, mostly branded innovator drugs. Patients also abuse, even if they need to stay only 2-3 days in hospital, they stay 1 week, they pay only 5% of the total bill, why not over-stay. If you put allowance for abuse, people will exploit it. Japan is now the most indebted country on the planet, the only difference is that the bulk of its debt is domestic, not foreign.
      December 19 at 12:14pm · 

    • Melissa Guerrero That's why when we do universal coverage, we have to be wise on where we spend money and how much.
      December 19 at 2:08pm · 

    • Melissa Guerrero I also don't believe in a free-for-all healthcare system. No country can afford that. The Singapore 3M model is worth looking at in how they finance health care. Government comes in during catastrophic spending but citizens are required to have savings for usual hospitalization (Medisave). There should be personal responsibility as well to minimize abuse. I think that is what is missing in the UK and other health systems where government shoulders everything. But no doubt, there should be a social safety net that's either funded through tax or single-payer health insurance.
      December 19 at 3:11pm · 

    • Nonoy Oplas Yes, I also believe that PhilSick need not be abolished, it can be retained as last resort or add-on health insurance, people should assume more personal responsibility in healthcare, including personal finance via health insurance -- a private HMO, a cooperative or community healthcare, an LGU-sponsored healthcare. So people will have 2 insurance, one that is mainly private or NGO, another for PhilSick. The latter will be used only when one is really sick that he/she has to be hospitalized. For outpatient, dental, annual medical check up, Philsick cannot be used, one has to utilize the private/NGO/LGU healthcare services.
      December 21 at 8:53pm · 

    • Nonoy Oplas Btway, permission to use this exchange doc melissa, i want to post ths in our CHAT googlegroups? thanks.


I hope to read and make my own discussion by next year, on the papers that Doc Melissa gave.

Happy New Year friends.
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See also: