Editorial
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Volume 2012 Number 1
Health Politics
Neil Johnston: Friends of Science in Medicine
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Pharma-Goss for September 2010
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PDF version | Rollo Manning |
Rollo Manning has experienced pharmacy practice from all sectors of the industry – retail, administrative, policy and remote Aboriginal practice. He spent 10 years with Glaxo Australia and was the first Director of Public Relations at the Pharmacy Guild National Secretariat in Canberra. | |
Consumer welfare program or small business support program? This is a controversial question that is sure to invoke hot debate.
It is to be welcomed.
Is the PBS a consumer welfare program as a part of a total National Health Scheme or a small business support program for retail pharmacies?
Where does the balance lie and is the consumer getting the best deal of the arrangements?
That is the question.
How dare such an assertion be made that suggests the Pharmaceutical Benefits Scheme may have lost its way and moved from being a part of a National universal welfare program.
The truth is that there were 197 million PBS items supplied by 5,000 Approved Pharmacies in the 12 months to 30 June 2010. The amount paid in “dispensing fees” of $6.42 each item means the total paid out for this component of the total cost was $1.26 billion. Add to this the mark up on cost of let’s say $4.00 on the average price of $32.84 that adds a further $ 788 million. The Safety Net recording fee of $1.02 adds a further $201 million giving a total $ 2.25 billion of a total of $ 7.93 billion.
28% of the PBS spend, or on average $450,000 goes to each of the 5,000 Approved Pharmacies.
Is this a concern of too large a spend or a subject to rejoice at the size of the spend going to retail pharmacies. No doubt the Pharmacy Guild would rejoice and say that this is the cost of maintaining an efficient, sustainable (and “world best”) network of pharmacies to distribute the PBS to the Australian population.
Well let’s have a look at what is obtained for that spend across the socio economic sectors of the Australian population.
The higher income families or individuals living in the more affluent suburbs of the cities and regional centres have any number of pharmacies to choose from to obtain their PBS and no doubt have as good relationship with any number of pharmacies. Take Lindfield in Sydney for example where there are six pharmacies within a two km radius. These people will receive their PBS medicines together with counselling and maintenance of their Safety Net record - should they spend an amount in excess of $1265 in any one calendar year they obtain their benefits cheaper.
The middle to lower income families or individuals will obtain a similar service to the above group regardless of where they live – be it an inner suburb of a big city (Collingwood in Melbourne has four pharmacies within 500 metres of each other) or on the outer fringes of a rural town. Geraldton in Western Australia has six pharmacies within 1.5 Km radius. Plenty to choose from and obtain the same advice and support as the high income earners.
In small rural and remote townships where there is one pharmacy again the same amount of dispensing fee is paid and the clients can expect exactly the same service as the urban dweller. In fact their pharmacy will get an additional allowance to ensure its sustainability over and above the amount already paid as part of their share of the National average of $450,000.
But if that pharmacy in the “one pharmacy town” is not performing and another pharmacy is seen as being needed to provide competition – market forces at work – a pillar of the free enterprise way of doing things - the new pharmacy would have to be located 10 Kms out of town – yes out with the abattoirs, wheat silos or sewerage farm.
Aboriginal Australians living in urban areas get an added benefit of a reduced co-payment on the cost of their PBS because of their added risk of acquiring a chronic disease – and that applies to all people over the age of 15 years “at risk” – which means everyone. $88 million is to be spent on this added benefit for the 370,000 Aboriginal people in urban Australia in the next four financial years
The people who miss out entirely are the remote living Aboriginals in communities with NO Approved Pharmacy and no access to a quality pharmacy service like their cousins in the urban areas or remote/rural towns. For these 150,000 people their health clinic obtains its PBS from an Approved Pharmacy but unlike the urban dweller with access to a pharmacist (at $6.42 a script for advice) they get nothing and yet make up one of the most disadvantaged and multiple chronic disease sufferers in the whole of Australia.
The question really is how equitably is the $ 2.25 billion being spent? Is it necessary to have so many outlets in the cities, towns and suburbs and such ludicrous rules pertaining to supply to people in remote places? Why is there not some special arrangement for dispensing to the most vulnerable of all Australians – who are living in Third World conditions – the remote living Aboriginals.
This writer hopes that in the course of the next 4.75 years and towards the end of the Fifth Community Pharmacy Agreement, some action can be taken to refer the PBS back to its roots of being part of a universal welfare program for ALL Australians and less of a “cash cow” for too many retail pharmacies. That is one opinion – what is yours?
Any reader who wants to join this discussion or dispute any of the stats, figures or claims made in this item are invited to advise the author and keep in touch. Contact rollom@iinet.net.au or mobile number 0411 049 872
A PDF file Fact Sheet of this article with illustrations is available on request.
Mental health a big issue
So pharmacists get in there and play a part in helping to forge better relationships between people, organisations and government agencies. This will be the key to a more harmonious population in the future and at the grassroots community level is the place to start.
A full page advert in the daily newspapers listed 65 organisations that are members of the Mental Health Council of Australia and NO pharmacy organisations are included.
How long does it take for the so called peak organisations to take their responsibilities on behalf of the profession seriously and start talking to others?
The Pharmacy Guild talks about its key role and this is challenged by the Pharmaceutical Society of Australia saying that it really represents the total profession.
Maybe it is time for both to stop arguing and get on with liaising with other key organisations. The mental health of pharmacists is at stake and better relationships will go along way to building better links and forging partnerships.
For those interested have a look at the full page ad can be seen at
http://www.mhca.org.au/documents/MH_end%20the%20neglect_A3_print3.pdf
As this columnists likes to say –“It is not until you are out there doing it that anyone will know what you can do”
In terms of the future we must be talking with others and not just doing research is our own little cocoon of medicine supply experts – even this can be questioned. Any number of “roadmaps” and “paths to the future” will be worthless if the basic direction is flawed and end goal not clearly articulated and agreed with the profession as a whole.
See next item – A future role for graduated pharmacists.
A future role for graduated pharmacists
The Early Graduated Pharmacists Group of the Pharmaceutical Society of Australia is to be congratulated on its stand in seeking a wider role for pharmacists in primary health care. Just because a person is a “pharmacist” does not mean they have to be confined to the supply of medicines. The degree of Bachelor of Pharmacy should be only the starting point of a career that could take the holder anywhere in the health sector of the economy. People holding the degree can be found in over 12 different government departments at both the State/Territory level and Commonwealth public services. Jobs for policy officers are being continually advertised is areas of expertise where pharmacists have a basic training. Give it as go. If you would like to see more of the opportunities that exists and training options needed or offered to do the work effectively write to the author at rollom@iinet.net.au for a list of opportunities.
QUOTE OF THE MONTH
If a free society cannot help the many who are poor, it cannot save the few who are rich.
John F. Kennedy
(1917-1963, 35th American President)
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Submitted by Karalyn Huxhagen on Sat, 11/09/2010 - 10:43.
Hi Rollo raises a few issues that are still on the table even though a lot of money has been spent trying to make the access to pharmacy services more equitable for all Australians.
We now have several systems in place for the Aboriginal and Torres Strait Islander people to access pharmacy services. We have section 100 supply in remote communities which is the most ass about system in terms of providing quality pharmacy services.
Then we have Closing the Gap services for PBS copayment for urban dwellers, public hospital supply and QUMAX that provides other services like DAA's and access to pharmacy services.
So in fixing one problem we have created another as there is no connectivity between these programs. Therefore the more mobile of the Aboriginal and Torres Strait islander people are accessing different systems with different eligibility rules and payment structures. It is confusing to say the least.
In some communities we have different systems being managed by the practice as the outlying station is remote while the central Aboriginal health service is urban.
Then there is the Australian Pharmacy Council report " Remote/Rural Pharmacists project Final Report 2009" which provided recommendations on alternative modelling for pharmacy services in remote and rural communities. All major bodies including the Pharmacy Guild of Australia were part of the working party that developed this report. The PGA has publicly claimed that the APC report has no worth and dismissed its outcomes.
These issues have also been raised with the Australian Health Ministers rural steering group in a series of workshops around Australia
A lot has been done in the past 10 years but we still have a very long way to go.
Pharmacy services to outreach areas of Australia is not a pipe dream that can never be solved. There are so many models that already work in small pockets in both Australia and with other cultures like the indigenous people of Canada and America.
What we need is a willingness to look at the whole package of health services in these locations and develop protocols that allow pharmacists to do more than drop off a bundle of drugs (S100).
we can be providing health screening services, immunisation, chronic disease monitoring and oh so much more
I had hoped that the current Minister would have seen the opportunity for pharmacists expanded roles in what he has been presented with but alas the funding has gone to GP services and Divisions of GPs once again!!!
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