Albert Francis E. Domingo, MD

my flight of ideas

Power, Pesos, and Public-Private Partnerships in the Philippine Health Sector

Posted on | October 30, 2014 | No Comments

While it is acknowledged that the free market system and its perceived advantages as regards allocative efficiency can never take hold 100 percent due to so-called “market failures” (Morris S. et al. 2012, pp.114-132), Buse K. et al. (2012, p.52) points out that the general anti-state, pro-market trend of the 1980s arose due to allegations that “the public sector provided patronage instead of service, employment rather than goods and services, and used office to secure political support.” Health reforms said to be of “neo-liberal” influence have been instituted worldwide to various extents, with resistance seen to be coming mainly from actors content with the status quo of planned approches as well as from the “disproportionate emphasis placed on the technical content of reform at the expense of understanding the politics of the reform process.” (Buse K. et al. 2012, p.55)

Buse K. et al. (2012, p.58) cites the following contributions of commercial actors to governments as reasons for their prominence in health policy: revenues, employment, and cross-border influence among other states.

By way of an example, the potential for increased fiscal space was the pitch of the Philippines’ President Noynoy Aquino for public-private partnerships (PPPs) as he started his term (2010), when he said that “[the Philippines has] so many needs: from education, infrastructure, health, military, police and more. Our funds will not be enough to meet them… Our solution: public-private partnerships. Although no contract has been signed yet, I can say that ongoing talks with interested investors will yield fruitful outcomes.” Read more

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The Philippine Puzzle of Missing Medicines and Maldistributed Health Workers

Posted on | October 28, 2014 | No Comments

Unmet need for healthcare and its derived factors of production such as medicines and labour is not the same as demand for these factors (Dussault G. and M. Vujicic 2008). The combination of a shortage of pharmaceuticals and a surplus of labour on the background of unmet need may be seen in a low middle-income country (LMIC) like the Philippines. 

The Philippine medicines sector has (a) an overwhelming role for the private sector; (b) expensive drugs; and (c) households burdened with the onus of payment. Drug prices are high due to dependence on importation and the overwhelming share of branded products (even with many essential medicines that are already off-patent). This is mainly due to (a) households not knowing about medicines; (b) aggressive marketing; (c) heavy medical representation in drug sales; and (d) incentives given by pharmaceutical companies to prescribing doctors. (Picazo O.F. 2011)

High drug prices mean shortages for those who cannot pay. An effective change strategy will have to use carefully designed mixes of interventions involving as many stakeholders as possible (Haak H. 2008). One such example that should be scaled up further in the Philippines is the “P100 treatment pack program” or P100, which makes use of bulk procurement advantages of government (i.e., economies of scale) to purchase, conveniently package, and then sell drugs to families at lower prices. I agree with Picazo O.F. (2011), that P100 will be best implemented with more government financing in the short- to medium-term, and then capitation from the national health insurance program over the long term, with procurement to be open also to the private sector. Read more

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From Guilty Pleasure to Medicinal Measure: Evolving Cannabis Policy in the Philippines

Posted on | October 23, 2014 | No Comments

When is a drug “therapeutic” as opposed to “recreational”? The first term connotes an established usage in clinical medicine, while the second implies use for leisure with attendant state intervention in varying degrees across multiple jurisdictions.

Cannabis, which is more commonly known as marijuana, has the primary psychoactive ingredient Δ9-tetrahydrocannabinol (THC); other molecules found in its leafy plant include dronabinol and nabilone, both indicated as anti-emetics in cancer treatment and as anti-anorexics for patients with AIDS (Borgelt L.M. et al. 2013).  However, caution has been aired as regards risks versus benefits of medical cannabis use, most significantly with its primary psychotic action (Pierre J.M. 2010).

Following the framework of Calman K. (2009, p.e8)’s intervention ladder, the Philippine state can be said to have eliminated choice when it comes to cannabis, which is a heavily regulated (in fact, prohibited) substance by law (Anon 2002). That may change to something weaker (such as guide choices through disincentives, or even as weak as enabled choice) depending on how a proposed legislative bill will sail through Congress (Geronimo J.Y. 2014a). It would be worth mentioning in relation to the de jure prohibition of particular drugs in the Philippines as elsewhere that some attempts to rationally assess the harm of drugs of potential misuse have shown that such regulatory systems may have a different ranking, and one that may be based on an unspecified or obscured methodology or process (Nutt D. et al. 2007). Read more

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