Reimbursement system proposed for free medicine

Joseph Schembri

Aug 12th 2009, 15:42

@Stephen Spiteri: What you are saying is commonly referred to as 'The tragedy of the Commons' : a term coined in the late 60's to describe a problem commonly encountered in economics and environmental management.

To put it very simply the author of the influential essay bearing that title said that any resource that is perceived as being free is always over exploited.

In this case it is the abuse of the 'free' medicines system. Therefore the government should intervene and destroy the perception that medicines are a free resource open to over exploitation. There are several ways in which this can be done and you have amply outlined a few ways for this to be done.

Reginald Wilshire

Aug 12th 2009, 12:03

Well i often wonder i seen it with my own eyes i am retired and reside in Gozo, we have an E-111 blue plastic card, however when collecting my medication i see people carring great big plastic bags presumibly full of medications, what do they do with it all, and may i also ask if i may, on the main island Malta people collect medication once per .3. months however in Gozo every 2 months, what is the logic in this? or is Gozo as usual treated as second class to malta? just wondering thats all. Just incase people ask if we collect FREE its not we paid for it in our insurance back home, it looks free but deducted indirectly on a monthly bases at least in my case any road.

Danny Fischer

Aug 12th 2009, 11:51

Here we go agian the church again pokeing their nose where it doesn't really concerns them directly, alot of pensioners can't even afford to eat properly let alone pay for their medications. The Maltese brians is at work again, its hollow, in most eu countries medication that is life threatening is FREE although i must add there is a small amount of deductions taken from one's much much higher salary then Malta

Anne Marie Bonello

Aug 12th 2009, 09:24

@ Leo Said

It wouldn't make sense for the government to not plan supplies from before, becuase if they were to reimburse people on more expensive drugs then they would be at a loss don't you think?...

I agree fully with this system. Many people do not actually take their medications or do not take them as they are meant to. This means everytime they go to the doctor for a checuk up they are wasting both their and the consultants time because they wouldn't have improved. The doctor would then think the answer is to increase medications which results in even more drugs going to waste.

The fact that they first have to buy the drug themselves would make them more compliant.

Dr. John Zammit

Aug 11th 2009, 21:23

...and then they say they do not want to introduce divorce because it destroys the family...what are these doing then? Even the Church by saying that their should be chargeson medicine is destroying the family! The high bills on electricity, the high prices of medicine, the high prices of gas cylinders and the high expenses that everybody is receiving are breaking the family and now all we need is this to top up the disaster we are having in Malta

Franz-Josef Bartoli

Aug 11th 2009, 19:56

Mr. Fava, the government was elected on the promise of the PHARMACY OF YOUR CHOICE and not the Reimbursement system. Remember that your comments are scandalous as they reflect your CONFLICT OF INTEREST in the matter. Well, with your comments it is simply that you lost 3 members of the family from entering your pharmacies. Mr. Fava you must be ashamed of your yourself.

Leo Said

Aug 11th 2009, 17:47

Quote Joseph Schembri: "I can picture the scenario: Customer entitled to free generic medicine walks into a pharmacy but the pharmacist informs him that that particular brand is out of stock....."however we do have the same medicine under a different name..... at three times the price."

My answer: Your scenario is indeed the danger, which has to be controlled, and better still, be avoided.

Still, the customer/s would only have to pay the difference in price as compared to a generic brand, although this fact cannot be, and should not be, any consolation.

Government has been boasting about pharmaceutical generics, which are manufactured in Malta, and so, any dangerous, untasty scenario could be minimised.

Stephen Spiteri

Aug 11th 2009, 16:51

@ Mr Pace
It is the system that nourishes greed and egoism. If one is offered riches beyond his needs and comprehension it would be instinctively foolish to turn it down. The present system got the patients accustomed to be supplied with the plenty and not with the adequate.
And resources are not that vast! In the 70’s and 80’s the system was perfect. But after decades there is a clear need to revise the system. This applies not only to the cost of maintaining an equitable system but also to include previously unrecognized or uncommon diseases as lesser ailments are being treated in an irrational way with non-essential medicines.
I don‘t think that “Whatever we do in Malta is always wrong and what other nations do it is right”.
Malta is not a microcosm and its people do not have some kind of special needs which are not found elsewhere. Regional collaborations and benchmarking are the order of the day. Monitoring the local scene and evaluating other systems adopted by different countries is the way forward.
Devising the ideal policy by looking carefully at existing ones is much like becoming the reader is the essence of becoming a writer.

Anthony Magri

Aug 11th 2009, 16:44

Good idea Mr Fava provided, repeat provided the Government sends a cashier at each pharmacy so that as soon as the medicine is dispensed against a receipt the cashier will there and then reimburse the individual.
Reimbursements by government otherwise than through this system will never happen. Ask those who are due to receive reimbursment for Vat, Income Tax and particularly the importers of medicines.
Old age pension used to be paid in that manner. The pensionner shows his entitlemt cerificate and receives payment immediately.
What was done in the past could be done nowadays.
Of course a day and time will have to be fixed for the purpose of buying medicines and getting reimbursed immediately. We are seeing the effects of Mr. Zahra report on social services.

Joseph Schembri

Aug 11th 2009, 16:00

Reginald Fava: "On the other hand, patients who wanted to choose more expensive products could do so and pay the difference themselves"

Pull the other one it's got bells on!

I can picture the scenario: Customer entitled to free generic medicine walks into a pharmacy but the pharmacist informs him that that particular brand is out of stock....."however we do have the same medicine under a different name..... at three times the price."

Mike Magri

Aug 11th 2009, 15:56

Mr. Fava, i and many others like me, have heard and read you many times, agreably SCOLDING the government of not paying the importers of medicines in time..

please DON`T invent silly means whereby, the pensioner and the sick will pay and only God knows when, the Government will reimburse these `Imsieken`.... !!!!

Because, if you can assure us all of the government`s promptnes in the reinbursments of our prepaid medicinal expenses, then the same government should absolutely find NO PROBLEM IN PAYING ALL IMPORTERS ON TIME TOO....RIGHT...!!!

If we realy want to somewhat control the wastage of free medicines, we ought to go back to the system of the payment of Euro 1.16, (LM0.50, or even more), for each prescription issued, and not imposing additional HEFTY Financial Burdens on the sick and the pensioners.....!!!!

ITS A CRAZY IDEA, to say the least...

philip pace

Aug 11th 2009, 12:55

To Mr.Spiteri.
Your argument holds no water as Malta is neither one the countries that you mentioned.

Why is it Mr.Spiteri that whatever we do in Malta is always wrong and what other nations do it is always right!

Maybe Mr.Spiteri has forgotten that the free medicines, children's allowance and minimum wage and other social benefits came into practise in the 1970s while countries that he mentioned where nowhere near to this up til today.
Try what you wrote re Sweden and you produce another monster of a Govt branch titled Health Accountability. That can't work in Malta.

Or is it that a change is coming and this Government is using these culprits as an excuse to acheive this?

Re;the present system is greedy and egoistic! Explain yourself on this with facts. The system is good and please note as I together with hundreds are not so egoistic!.

We have a good system for Malta fit for the Maltese.

Catch the culprits, make them pay but keep the system!

C Micallef

Aug 11th 2009, 12:22

A VERY BIG ASSUMPTION INDEED!
Mr Fava is assuming that the authorities will continue with any new suggestions & further plans without considering the government employees' interests which are (hopefully) represented by UHM. Imagine if one had to propose that most state schools should close down because countless number of children are still going for private tuition anyway. So we start reimbursing parents for sending children for private tuition. Imagine how MUT, rightly so, would react!!!!!!

Galea. L

Aug 11th 2009, 12:10

Mr Fava and the Chamber, please keep your ideas to yourselves.
How can pensioners and people on social services pay for their medicines when even people who are working are nor making ends meet?
As for being reimbursed perhaps it will be their heirs who will receive payment if at all.
How about the people getting the medicines from pharmacies and then the government paying the pharmacies Mr Fava? Shouldn't that be better Mr Fava?
This is simply a feeler to see the reaction and an attempt to do away with extremely essential social services to those who cannot do without them.
How about the introduction of a payment of say 1 euro to eliminate waste?
But that would be copying PL and expose the PN to the attacks that itself perpetrated on the PL Government wouldn't it?

v.pulis

Aug 11th 2009, 12:04

'In the 1996-1998 legislature, the then Labour government had introduced a much criticised €1.16 (Lm0.50) fee on each prescription. Mr Fava said this acted as a deterrent against wastage and should not only have been retained but increased.'

I disagree with this kind of measire because in the end only those patients who really need the medicine will be left to pay the fee.This is confirmed by the quote below;

"He was certain this system would reduce wastage since patients would think twice before paying for a medicine they did not need, even if they were going to be reimbursed."

The proposed measures are an admission that the persons who are abusing the system cannot be caught so the burden is being thrown on everyone's shoulders but mainly on the honest patients' as the ones abusing can opt out.

Stephen Spiteri

Aug 11th 2009, 11:44

Only in Malta and in Ireland there is no form of co-payment from those entitled to free medicines. Reimbursement is not enough. An equitable cost sharing scheme must be set up firmly in place otherwise the system is going to collapse.
For example in Sweden they introduced a graduated cost-sharing scheme. Over the course of one year patients pay the full cost of reimbursable drugs until they have spent the threshold level of 87 Euros. Once the threshold level has been reached, patients pay a fraction of the total cost of any reimbursable drugs they purchase. The level of the patient co-payment diminishes with the cumulative amount spent until a maximum of 418 Euros is reached, above which all medicines are provided free of charge to the patient. The maximum (most patients pay less) amount in any given year a patient will spend on medicines under this system is 174 Euros.
This is not a high price to pay for a sustainable system whereby the needy of tomorrow are also taken in consideration! The present system is greedy and egoistic.

philip pace

Aug 11th 2009, 11:37

Futhermore, I hope that the Government would be sane enough not to consider this proposal as it is not the right solution as I have explained it before that this proposal is viewed from one side only, as how the CCEI thought only of themselves and their businesses.
They did not even bothered to see how it would hit the low income Maltese families as I am sure that don't belong to this category, never did and cannot imagine how difficult it is to be living under such circumstances.
I consider that the CCEI went miles away from finding the ideal solution as their solution is not beneficiary to the great majority of Maltese families.
The reimbursement is an unproductive idea as it would burden the present over taxed Governemnt who simply can't afforn to create another branch/office where it has to keep track with payments/reimbursements for the medicines.
I thought that CCSI was more understanding and realistic on a such important fundamental right here in Malta!!!

g. scerri

Aug 11th 2009, 11:25

The importers of medicines that carry the highest price-tabs in the EU can hardly be relied upon to ensure social justice. I believe their motto is: the business of business is business. That says it all.

philip pace

Aug 11th 2009, 11:22

The following is what I believe on what this country is governed on.
First, if the Government is concerned on medicine wastage then the same Government should know who these culprits are and deal with them one by one but leave the majority of other who are innocent.
Second, if the Government is concerned on social benefits abuse then the same Government should know who these culprits are and deal with them one by one but leave the majority of others who are innocent.
Third, way back in the 70s when the a law came out it was termed by the then opposition as an unjust law as due to the fact that few people were breaking the law, the majority of others who abided by the law were punished for doing so. That was, yes unfair and anti social.

The point is don't generalise, do not consider that all the people are doing this, praise those who abide by the law and just for a small number of culprits don't change the law and admit your faults!

Deal with the culprits right now and check out how this is allowed to happen from the Government side.

(continued)

Leo Said

Aug 11th 2009, 11:18

With respect to necessary "Controlling" in a Health Services System, Mr.Fava's suggestion does make sense and is practicable.

As an addendum, one should say that government should then make public what is known as a "positive list" in Health Services Administration.

A "positive list" means a list of medicines (drugs, pills and similar), which government or an insurance company are willing to accept as their respective standard. The major ingredients of a "positive list" are usually "generic" brands, which, as a rule, are clinically as efficient as more expensive medicines of corresponding category.

Sylvana Zarb Darmanin

Aug 11th 2009, 11:06

I disagree completely with Mr Fava's suggestion! It is already bad enough with pensioners receiving a pro-rata cost-of-living increase; having to fork out money for their medicinals will undoubtedly create problems. The Government should ensure that only the necessary medicine is given out. Mr Fava's suggestion is definitely not the solution to this!

Michael Neville Cassar

Aug 11th 2009, 10:12

Is this a new way to break the welfare state? It sounds good but it smells as people who have never needed medicine may suddenly require medicine which they wouldn’t have the money to buy them with.

C.ZARB

Aug 11th 2009, 09:39

Considering the efficiency in which the government's departments work, you will end up being paid in 2020 for the pills you bought in 2010.

philip pace

Aug 11th 2009, 09:33

It is not a good proposal as Mr.Fava failed to notice that only flaw about it is when the patients would be reimbursed by the Government. It probably does not concern them or entered in their minds
It is what one call a proposal seen from one point of view.
The CCEI saw it only from their side.
The same CCEI failed to realise that when the Government comes to pay out it takes a very long time to do so but is very good to come out with grand plans with the money coming from the people's pockets (Piano)!
Therefore the CCEI is totally detached from the nation's realities as they failed to recognise that the Electricity/Water tariffs have gone up plus the increase of butane gas.
I ask the CCSI how much more are the people going to pay for a gross incompetent Government.
I think that the people should not burdened with such flimsy and unattainable schemes.
And now the CCEI think that what the Labour Government did in 1996 to 1998, re the €1.16 payment, was a good measure to cut down wastage and should have been increased?
What's next?

Josianne Cardona Gatt

Aug 11th 2009, 09:29

I do understand that there are a lot of people who abuse of the system and that many times wastage of good medicine is a concern to all of us who contribute with their taxes to the system. It would be good to have people pay from their own money and then be reimbursed by the government, but what about those people who don't even have enough money to buy all the medication needed? What would happen to those people who have to buy certain specific pills which if you total them up at the end of the month their costs would by far be more then their monthly pension? Before one comes to such hard and fast rule, one has to think of all straights of society and what the implications would be.

A. Farrugia

Aug 11th 2009, 09:24

"In the 1996-1998 legislature, the then Labour government had introduced a much criticised €1.16 (Lm0.50) fee on each prescription. Mr Fava said this acted as a deterrent against wastage and should not only have been retained but increased."

... and Labour was branded as lacking a social conscience for doing this. This was a very bold move by the then MLP, as it placed the financial sustainability of the system at a priority without jeopardising the system's effectiveness, whilst only marginally increasing the (financial) burden on society. I'm sure EVERYONE (except those with fixed blinkers on) would agree to pay a minimal 1.16 Euro fee if that would mean a lot less 'out of stock' medicine for those who REALLY need it. Alas, Malta's history is what it is, and we generally learn our lesson when it's too late, ... or is it?

I'm in favour of this fee. The hoarding of free medicine is an unfair, ridiculous and financially unsustainable practice that HAS to be ruled out. Common sense should be put before votes and the government should re-introduce this fee or a similar deterrent to curb this abuse.

victor caruana

Aug 11th 2009, 09:15

Bravu l-boy!!

Transfering business risk to patients. this on top of being fleeced by the pharmaceutical sector with inflated prices. Mr. fava should recommend goverment to import generic drugs to replace expensive similar brand drugs which local businesses insist on.

anyway, the recommended system will be too costly to run.