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ELEEN Ooi, 38, could not believe her eyes when she got the bill for the removal of a peanut stuck in her four-year-old daughter’s nose.

The private hospital’s itemised bill for the 15-minute procedure ran into two full pages and came up to RM4,000.

And she noticed that she was charged RM43.60 for a baby nasal spray which she could get for RM27 from a pharmacy.

She, like many patients, alleges that hospitals are charging high prices for drugs and services resulting in high insurance premiums in the country.

Drug prices are a major contributor to high healthcare costs and the government should regulate them across the board and at every dispensary, she says.

“The price of drugs needs to be more affordable for the public, especially drugs where patents have expired,” says Ooi, a lecturer.

She says when people cannot afford to sustain paying for the high costs of medicine, especially those taken for the long-term, they are forced to use the public health system.

For this reason, she welcomes the Cabinet’s decision to impose drug price controls.

A solution to fit all

Health Minister Datuk Seri Dr Dzulkefly Ahmad says the Cabinet approved the measure on April 12 and that the ministry will get pharmaceutical companies’ responses on the price control mechanism this month.

The ministry will use external reference pricing to benchmark drug prices in Malaysia, choosing the three lowest prices and averaging them to determine the ceiling price.

The ministry has not decided which country’s system it will model the control mechanism on, he said at a press conference held recently in conjunction with Pakatan Harapan’s first year in office.

Dzulkefly says the ceiling price will be imposed at the wholesale level as well as the retail/consumer level at clinics, hospitals and pharmacies.

Controlling the prices of drugs is provided for in the Price Control and Anti-Profiteering Act 2011, which is monitored by the Domestic Trade and Consumer Affairs Ministry. The Cabinet has agreed that this ministry will appoint Health Ministry officers as price assistant officers to carry out drug price control enforcement activities, he says.

Dzulkefly says the move will ensure that people have access to affordable drugs, especially expensive new drugs; it will also encourage innovation and healthy competition for industry growth.

The private sector may not be happy with a price control but the country needs a solution that fits all, he says.

It was recently reported that Penang Institute political studies senior analyst Lim Chee Han had quoted the 2017 Medicine Prices Monitoring report showing that the median mark-up for originators’ and lowest-priced generics’ retail prices in private hospitals was 51% and 167% respectively.

In pharmacies these figures were lower, at 22.4% and 94.7%.

“This shows that the mark-up range can be exceedingly large; in some extreme cases in private hospitals, it could even spike up to 117.4% and 900%!” Lim says.

NGOs welcome move, industry wants competition

Non-governmental organisations (NGOs) welcome a drug price control but local drug producers prefer market competition.

Third World Network (TWN) adviser Dr Lim Mah Hui says he supports the effort but it should not be rushed as it is a complex issue and the government needs to look at different models and choose the best to emulate.

Dr Lim says there is a lack of transparency in drug pricing at different levels – manufacturers, middlemen, pharmacies, hospitals and clinics – and there should be some regulation of the price range they can mark up.

“We hear about discriminatory preferential pricing. Manufacturers selling (the same) drugs at different rates to different buyers and some medicines not being made available to certain pharmacies.

“I am not saying that the industry should not make a profit, but the profits should be reasonable,” he says.

Africa introduced a single exit price in 2004 which requires the manufacturer to declare the price when the drug comes out of the factory. It also put a stop to discounts and preferential pricing, he says.

In June last year, The Star quoted Dr Lim saying the government should initiate centralised purchasing and regulate drug prices as is done in advanced countries, and carry out a study on the drug procurement system to ensure drug prices are affordable.

Last August, TWN programmes director Chee Yoke Ling also highlighted the need to tighten up unnecessary patent monopoly and additional patents that extend monopolies beyond 20 years, pushing up the cost of some crucial medications.

Malaysian Pharmaceutical Society president Amrahi Buang says the government’s decision shows it has the political will to address this chronic problem, calling it a “major breakthrough”.

He adds, “The price control should not be applicable to all types of medicines but should focus on medicines requiring prescription and also address proper labelling and itemised billing,” he says.

Meanwhile, Medical Practitioners Coalition Association of Malaysia representative Dr M. Raj Kumar recently said that prices of drugs should be controlled but this should be done in tandem with the harmonisation of the fee schedule for general practitioners with private hospital-based doctors.

Malaysian Organisation of Pharmaceutical Industries (Mopi) president Billy Urudra says Mopi, which is made up of 45 members who are mostly local generic drug manufacturers, prefers that open market competition determines fair price instead of a price control. This was expressed to the Health Minister in a townhall meeting on April 2.

He says it is more important for the government to expedite approval of generic drugs to get them into the market faster and allow competition, and to update intellectual property laws to prevent the lengthening of protection for innovators that leads to continuous high prices.

A mechanism to establish a price based on prices from various countries seems acceptable, Urudra says, but it is best to choose a country that has a similar economic growth as Malaysia because benchmarking against developed countries may result in higher prices, he says.

Although Thailand and the Philippines do not have such a control mechanism, the prices in these countries could serve as a comparison, he adds.

Consider cost variance

While the Pharmaceutical Association of Malaysia declined comment for this article, the Association of Private Hospitals of Malaysia president Datuk Dr Kuljit Singh says the association does not support a move that seeks to control the prices of medicines in private hospitals.

Unlike dispensing in a retail pharmacy, medication administration in a hospital involves other costs, such as medication review, drug counselling, compliance monitoring, and titration of dosages as patient conditions change, he says.

He says there is a host of direct and indirect costs associated with dispensing medications in a hospital, which varies across private hospitals depending on geographical locations, levels of service, and specialities.

“We have cautioned against a blunt policy that disregards this cost variance and brought this up with the Pharmaceutical Services Division at a townhall meeting on Feb 28 this year.

“We were given an undertaking it would be considered,” he says.

Dr Kuljit also says that such policy and regulatory measures should be made in tandem with adjustments to private hospitals’ overall payment system where direct and indirect costs are lumped together into a few chargeable items – medication services is one of these.

“This was the result of a distorted payment structure for private healthcare where proposals to realign increases in these costs to their proper categories – such as room and board rates – were met with resistance.

“The increases were inevitable due to a number of factors such as inflation, exchange rates and higher manpower requirements,” he says.

Asked what other charges are lumped together with medicines and other “charge-able items”, Dr Kuljit says there is expensive equipment that hospitals can only charge for when used such as medical pumps, used after cardiac surgery in an emergency.

On why drug prices in private hospitals are much higher than that of drugs sold in pharmacy outlets, he says the overhead costs of running the pharmacies are lower and they can buy in bigger bulk.

Dr Kuljit argues that private hospitals make an average of 5% to 7% profit, up to a maximum of 10%, and this is considered low.

Ooi, who is also a business consultant, questions the need for the high mark ups on drugs when the hospitals are already charging for almost every other possible thing, including cotton wool.

“The only way to show proof is to see their bottom line,” she says.

Private hospitals have captive customers which retail pharmacies do not have, which indicates a higher economies of scale, she argues.

Moreover, most retail pharmacies are placed in prime locations with rental per month ranging from RM7,000 to as high as RM50,000, she says.

Meanwhile, TWN’s Dr Lim asks if private hospitals are not making money hand over fist, adding that the CEO of one healthcare company is one of the highest paid CEOs in the country, earning more than RM33mil last year, according to reports.

“And are the big private hospitals not making huge profits, or else why are they expanding?” he asks.

For decades, Malaysians have complained of high medical charges, with some facing a financial catastrophe or maxing out their insurance coverage in a health crisis. High drug costs are a major concern here.

The drug price control measure and a central pool procurement system for medicines (to begin at the end of the year) are the bold measures the government has announced it will implement to address the issue.

However, in tandem with these measures, the government also needs to remove the unnecessary extensions of patents and examine the role of the middleman in the drug supply chain to the government.

GLASGOW (Bloomberg): Eating rice may help prevent obesity, research suggests.

Experts found that people following a Japanese or Asian-style diet based on rice were less likely to be obese than those living in countries where rice consumption was low.

Researchers said low-carbohydrate diets “which limit rice” are a popular weight-loss strategy in developed countries but the effect of rice on obesity has been unclear.

They looked at rice consumption in terms of grams per day per person and calorie intake in 136 countries.

The researchers calculated that even a modest increase in rice consumption of 50g per day per person could reduce the worldwide prevalence of obesity by 1% (from 650 million adults to 643.5 million).

Prof Tomoko Imai, from Doshisha Women’s College of Liberal Arts, Kyoto, Japan, who led the research, said: “The observed associations suggest that the obesity rate is low in countries that eat rice as a staple food.

“Therefore, a Japanese food or an Asian-food-style diet based on rice may help prevent obesity.

“Given the rising levels of obesity worldwide, eating more rice should be recommended to protect against obesity even in Western countries.”

Giving possible reasons why rice can help, Prof Imai said rice was low fat, adding: “It’s possible that the fibre, nutrients and plant compounds found in whole grains may increase feelings of fullness and prevent overeating.”

The authors concluded: “The prevalence of obesity was significantly lower in the countries with higher rice supply even after controlling for lifestyle and socioeconomic indicators.”

Tam Fry, chairman of the National Obesity Forum, said: “We have known for centuries that Far Eastern populations tend to be slimmer than in the West because rice is a staple food, but few obesity specialists may have appreciated why.

“This novel research is the first to hypothesise that we could nail obesity by eating a modest amount more.”

IPOH: Educational enforcement on smoking ban will be intensified in rural areas nationwide, says Deputy Health Minister Dr Lee Boon Chye.

He said support of the ban at urban areas was encouraging, but there were still pockets of non-compliance at rural areas.

“We need to enhance educational enforcement at villages, and out of town areas, because we find people settling there are still not adhering to the ban,” he told reporters at a health community event held in Gunung Rapat here on Sunday (April 28).

It was reported recently that the ministry had extended the six-month educational enforcement period that was enforced in Jan 1, this year.

Dr Lee said the extension did not mean that people could smoke at open air eateries.

“If people are still smoking openly at such eateries, refuse to follow advice, they can be issued a fine.

“We are not punishing smokers, but our intention is to give them a chance to quit, reduce smoking or if they can’t do that, then at least they should not smoke in public,” he added.

On claims by restaurant owners that their business was dropping, and the economy was affected, Dr Lee said “The government collects between RM4bil and RM5bil in taxes from the tobacco industry annually, but spends at least RM16bil a year to treat smoking related illnesses.”

KUALA LUMPUR: In their imaginary world, children could be superheroes fighting fearsome monsters.

In real life however, children are quite helpless against many threats to their health and well-being – influenza is one of them.

Worldwide, this disease is responsible for between 290,000 and 650,000 respiratory-related deaths annually, many involving young children.

Younger age, higher risk

Children are a high-risk group when it comes to influenza. While healthy individuals tend to experience mild to moderate symptoms, young children may suffer severe flu.

This is shown in a study where children hospitalised from influenza were either admitted into intensive care (12%), developed respiratory failure (5%), had bacterial co-infection (2%), or even died (0.5%).

The US Centers for Disease Control and Prevention (CDC) also estimates that every year, flu-related hospitalisation among children younger than five years ranges from 7,000 to 26,000 in the United States.

This could be because such young children have immature immune systems. Furthermore, those below six months are not old enough to be vaccinated against influenza.

Children with pre-existing medical conditions have a higher likelihood of getting hospitalised for influenza. Of the 40% of children studied by Dawood, 18% had asthma, 15% (of those below two years) had been born prematurely, and 7% had developmental delay.

However, this does not mean that other children are safe.

A 25 year-long study of 1,665 healthy children found that influenza was associated with high death rates in otherwise healthy children aged below five years.

Acute otitis media (painful middle ear infection) and lower respiratory tract disease were highest among children aged under two years old.

Children easily catch and spread influenza

Influenza can spread in a couple of ways. If an infected person coughs or sneezes openly, influenza viruses are released into the air.

When inhaled by someone else, these viruses make their way into the respiratory tract and start to replicate.

Alternatively, the droplets may land on, or be transferred by touch to, items like toys, remote controls, door handles, bed sheets, blankets and so on. The viruses can live there for hours or days.

In that time, anyone handling those contaminated objects (called fomites) will get the viruses on their hands and eventually into their mouths, nasal passages and eyes where the viruses can enter the body.

Seeing how children share toys and have close contact with their school friends, siblings and other family members, it is no surprise that they can easily catch and spread the disease.

In fact, they shed greater amounts of the virus for longer periods than adults do, despite displaying symptomatic illnesses for a shorter time. All this often comes at their own and their family’s detriment.

A study by Principi et al found that most children with influenza attended day-care centres or schools. They also had a higher likelihood of fever and croup (an infection of the upper airway characterised by a barking cough), and a longer school absence.

Their parents and siblings also had more respiratory illnesses, needed more medical visits, missed more work or school days, and needed help at home to care for the ill children for a longer period of time.

Vaccinate children against influenza

It helps to teach children good hygiene and etiquette to reduce the risk of influenza infection, to some extent. These include hand washing, and staying away from friends who show signs of influenza.

However, vaccination is the best way to prevent influenza.

The CDC recommends vaccination for all children older than six months (as well as adults who care for children).

Two doses of vaccine should be given to children aged six months to eight years while only one dose is required subsequently.

Influenza vaccination should be given annually to protect against new mutations of the viruses that are expected in the coming season.

This will substantially reduce the risk of severe disease that may result in hospitalisation or serious complications.

It will also help prevent the virus from spreading at home (particularly if you have a baby under six months old) or in school.

While temperate countries experience influenza seasons in winter, we in Malaysia have it all-year round. As such, you should get your child vaccinated as soon as possible, and repeat the process every year.

Article courtesy of the Immunise4Life programme by Health Ministry, Malaysian Paediatric Association and Malaysian Society of Infectious Diseases and Chemotherapy, supported by Sanofi Pasteur. Learn more at https://immunise4life.my/beattheflu/ or http://www.ifl.my/btf.
Read more at https://www.thestar.com.my/news/nation/2019/04/24/influenza-a-real-threat-to-young-children/#Yew6GMrVIuY5lsVG.99