Albert Francis E. Domingo, MD

my flight of ideas

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.

Meanwhile, anecdotal observations say that “the lack of health workers is only a symptom of the problems besetting the healthcare system,” and that “the real problem lies on the distribution of health workers.” (Ermitanio N.A. and V. Alviar 2014) There is most likely an equilibrium shortage rather than a dynamic shortage according to the discussion of Morris S. et al. (2012, p.201). It may still be the case that non-competitive compensation packages in monopsonic institutions or the geographic location of available positions (i.e., in isolated localities) are discouraging healthcare workers in the Philippines to start working (Institute of Health Policy and Development Studies 2005, p.42). Recent government interventions have been targeted to increase demand, by among others (a) increasing the primary demand for health services through expanded insurance coverage (i.e., demand-side financing); and (b) increasing resource envelopes at the regional level similar to Dussault G. and M. Vujicic (2008, p.301)’s pitch.

[Note: This is provided purely as an example of one of the academic requirements (specifically, the online seminar) of the course “Health Systems Analysis“ offered by the Global Public Health Unit, School of Social and Political Science, University of Edinburgh. The views expressed are entirely my own, and are not necessarily offered as expert advice in this forum of the internet.]  

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