The Press MONDAY, AUGUST 17, 1959. The Bill for Drugs

Press, Volume XCVIII, Issue 28975, 17 August 1959, Page 10

The Press MONDAY, AUGUST 17, 1959. The Bill for Drugs

An increase in the cost of

pharmaceutical benefits last financial year (1958-59) by £645,802 to £5,112,343 has, very

properly, been the subject of close attention by the Clinical Division of the Health Department; and the division’s discussion of the question is one of the most interesting sections of the department’s annual report. Any increase last year might have been considered disappointing because the previous financial year (1957-58) showed a reduction of £106,016 on 1956-57—suggesting that the rising annual cost of pharmaceutical benefits might at last have been halted. Last year there was not only an increase; it was an increase of the substantial order of more than 12

per cent. The Clinical Division’s examination of the subject is extensive and objective. While the division is not satisfied that the cost of drugs is as low as it should be, it points out that over a 10-year period drugs have risen in price less than consumer goods generally. If the cost of prescriptions had increased at the same rate as the Consumers’ Price Index, they would have averaged 8s lOfd each in 1958-59 instead of 7s Hid. The division says that expenditure on high-cost drugs is not necessarily ■wasteful and sometimes can produce substantial direct savings. It instances in particular the three drugs introduced since 1947 which have revolutionised the treatment of tuberculosis. Drug therapy has so reduced the number of patient-days in hospital that the division estimates that in 1957 alone a saving of £ 420,000 in hospital costs can be credited to these drugs. Heavy bills for drugs, therefore, clearly cannot be condemned out of hand. Yet the national pattern of drug consumption, it is equally clear, is far from satisfactory.

The division draws special attention to remarkable differences in prescribing in the four pricing areas into which the Dominion is divided. Last year, the average cost of a prescription in Auckland was 8s 3d, in Wellington 8s Od, in Dunedin 7s Bd, and in Christchurch 7s sd. Th>, division points out that, applied throughout the Dominion, the “ Auckland “ pattern ” would have cost the country an extra £425,000 last financial year; the “ Christ- “ church pattern” would have saved it about £BOO,OOO. The Christchurch pricing area covers a substantial part of the Dominion, including the Nelson, Christchurch, and Timaru health districts and about 20 per cent, of the doctors in the country. The Director of the Division of Clinical Services (Dr. A. W. S. Thompson) sees no reason why something closer to the kind of prescribing that satisfies the public in the Christchurch area, where the standard of practice is, in his opinion, second to none, should not be applicable elsewhere. A table that demon-

strates one important factor in variations between the districts is reproduced at the foot of this article. It shows the prescriptions for each 1000 population in the four pricing office areas for the broad spectrum antibiotics; the average cost of these prescriptions last year was £2 3s 7d.

The division comments that it will be seen from the table that while Christchurch doctors, on the whole, have tended to cut down these “ expensive and “ potentially dangerous “ remedies ”, those in other districts have been using them more freely year by year. “Auckland, which has been “running at 92-130 per cent. “ above the 1956 Christchurch “ level, has been prodigal “ indeed. It may well be that “ the top half of the North “ Island, with its sub-tropical “ climate, has more need for “these drugs than the Christ- “ church area, but it may be “ questioned if this would “justify doubling their use”. The director could well have pointed to another marked disparity that cannot be explained by “ sub-tropical climate ”, This is the remarkable increase in prescriptions in Dunedin in 1959 compared with 1956, while over the same period the Christchurch prescriptions actually fell.

Turning to the question of remedies for the unsatisfactory situation, the division sets out a number of ideas that should improve prescribing. Busy doctors, the division appreciates, need help if they are to keep up with new drugs and are to put everything that is offered them by the drug houses in perspective. The division uses a number of methods to keep doctors informed about the relative merits of drugs and the costs of prescriptions; and it has lately begun to supply to doctors a detailed analysis of a representative batch of their own prescriptions. Certain “ expensive prescribers” have been advised that disciplinary action is being considered. The division says it maintains, as far as it can, personal contact with doctors in their surgeries: and with the idea of improving this contact it has recently appointed an experienced general practitioner and consultant physician to visit general practitioners in all parts of the Dominion to discuss prescribing problems and offer information and advice. All in all, it seems thctt the Clinical Division of the Health Department is attacking an admittedly difficult problem with care, tact, and tenacity. It could not go much further—if that were desirable—without danger of interfering unduly with the relationship between patient and doctor. The doctor, of course, has the last word as to what his patient should receive. The division’s first object, therefore, is to secure the active and willing co-operation of doctors; and it is clearly in the interest of both the public and the medical profession that it should succeed.