THE PRESS WEDNESDAY, MARCH 17, 1982. Prescription charges

Press, 17 March 1982, Page 26

THE PRESS WEDNESDAY, MARCH 17, 1982. Prescription charges

The suggestion that people should be charged for drugs supplied on a doctor’s prescription appears to enjoy greater support in the ranks of the Government than it did when a 35 cent fee per prescription was suggested nearly five years ago. This is surely a reflection of greater concern about the size of the Government’s deficit than the result of any considered judgment that an idea rejected in the past is now sound. The obvious objection to the proposal is that it will impose financial burdens on those least able to bear them and deny groups in need adequate health care. The Minister of Health has attempted to answer this by suggesting that there would be maximum payments per family or over a period. Mr Malcolm has claimed that this would spare the chronically ill or those, especially families, on low incomes from having to go without drugs which their doctor believes they need. But the administrative complexity of any system of concessions and exemptions from the proposed charges could easily negate any savings made from requiring those able to afford drugs prescribed to pay for them. The cost of administering any system of charges, even one which makes no allowances for people in special need, could well reduce the savings to an inconsiderable amount.

. Even, after making allowance for people such as the chronically ill or large families on low incomes, the Government has laid itself open to the allegation that it is treating the nation’s health lightly. If the charges for prescriptions are high enough to make any worth-while savings in government spending, some people will be discouraged from going to their doctor or from having their prescriptions filled. The eventual result could be more patients in hospital, at a very much greater cost to the Government than paying for the prescribed drugs.

By the Minister of Health’s own admission, the Government's main aim is to help provide tax relief by making users of prescription drugs foot part of the bill which the Government has been paying. A sounder approach would be to examine ways of reducing the over-all bill rather than of simply transferring the charges. In the back of the Government’s mind seems to be a belief that there is room to reduce over-all spending on prescription drugs

without detriment to the nation’s health; The fault, it has been suggested, rests with some doctors wh’o dispense too many unnecessary prescriptions. Doctors’ representatives have rejected this suggestion. Even if it is correct, making patients pay for drugs prescribed is an ineffective way of curbing any errant doctors. The deterrent to waste is being applied in the wrong quarter with the suggestion that patients pay for having prescriptions filled.

There are some grounds, however, for believing that New Zealanders take more drugs than they need to to remain in on recover good health. Some room may exist for savings on the country’s bill for drugs without running any risk that anybody will be deprived of drugs they need. This line is already being pursued. The Health Department has had working parties looking at ways of holding back increases in the costs of pharmaceutical benefits. Restrictions on payment from public funds for minor tranquillisers and hypnotics are already in effect, as are “period of supply" restrictions. Part charges for certain drugs already provide an incentive, for doctors sensitive to the financial situations of some of their patients to economise by prescribing less expensive but as efficacious alternative drugs.

If the Government were to state that its goal was not to make the user pay, that is merely shift the cost from the Government to the individual, but to hold down the amount paid over all for prescribed drugs, it should quickly gain, the co-operation of the community and the medical and pharmaceutical professions. By proposing to charge for having prescriptions filled, frankly admitting that its main concern is economic and a hope to reduce taxes, the Government has forfeited the support of those whose main concern is to see the health of individual New Zealanders protected whatever their financial situation. The need for cuts in Government spending may be pressing but not so pressing that such a significant break With the principle that health care should be free or nearly so should be entertained. Other opportunities for curbing Government spending, even spending on health, which do not breach this principle should be explored before any ill-advised charge is imposed on having prescriptions filled.