EDITORIAL: Drug Service costs must be cut

HEALTH CARE in Barbados is not free.Yes, Barbadians do not have to pay for medical attention from the primary level at the polyclinics to tertiary care at our lone general hospital. And, yes, children under 16 and seniors 65 years and older, as well as those with chronic diseases, do not pay to get drugs from pharmacies that work with the Barbados Drug Service (BDS).But though the average citizen maynot have to pull their pocket each time they receive care or medication, there is a cost attached to providing that service – and those costs have spiralled out of control.For the provision of drugs alone, it was revealed on Monday that expenditure has trebled in the last ten years, with an increase of approximately 325 per cent.Minister of Health Donville Inniss has stated his intention to bell this cat. He would not be the first minister to attempt this task, but he has two factors – one in his favour, the other against – pushing his decisions. The first is the advantage of the preparatory work done by previous ministers to reform the system. Such work has been long and painstaking as it involved staff training and skills building, expansion of technology, better and more appropriate accommodation, public education campaigns, and so on.The second is the pressure of having less money allocated to pay for providing drugs, with little likelihood of getting much more. Inniss said on Monday: “This year my ministry has been allocated $35 million for the BDS, and this does not include the Queen Elizabeth Hospital’s (QEH) expenditure on drugs.”However, last February he noted Government was spending in excess of $50 million annually to facilitate the smooth operation of the BDS, with an additional $16 million on the QEH pharmacy.The message is clear: Drug Service costs must be reduced.A critical move in responding to this challenge has been the recategorisation of the Barbados National Drug Formulary. The latest edition being circulated to doctors has fewer brand name products and more generic drugs. Generics do not look the same as the brand name products, even though they have the same active ingredients and should work in exactly the same way. Their advantage is that they cost much less. Another definitive step taken has been the increased computerisation of the BDS to ensure greater efficiency in knowing what is in stock, and tracking what has been dispensed and to whom.This should address the wastage in the system. It should also cut down significantly on some patients’ penchant for “doctor hopping” and hoarding drugs, as the BDS would know when a patient last received medication, what it was for, and how long it was intended to last.Yet to be tackled is the thorny issue of whether Barbadians should be asked to pay a small fee for their medication. At present, Government, through the BDS, pays pharmacies handling fees – these being essentially calculated on the percentage cost of the drug being dispensed.It is known that pharmacies would be reluctant to collect this money as they could be faced with situations, for example, of elderly customers needing medication but being unable to pay the handling fees attached. Eliminating this expense will significantly reduce the costs to the BDS. If Inniss is to bell the cat of high costs associated with the BDS and to ensure its sustainability, this is one aspect his Government must address.