"Why
is it", I ask, "that within the whole health system, only
PBS costs are always listed separately?" Over the 38 years
I've been a pharmacist the PBS seems to have always been under pressure,
a threat made easier by the fact that it has its own "bucket
of money".
This siloing of different health costs means little thought is given
to offsetting pharmaceutical costs against any reduction in general
health expenditure.
We continually hear or read about the "spiralling cost of drugs"
but very little about reductions in hospital admissions due to these
new drugs.
Even in the hospital sector, it is rare to offset drug costs against
savings (where they occur) elsewhere.
One of the very early exceptions to the rule that drug costs exist
in isolation was the move by Veterans' Affairs to take the long-term
view of health care by listing nicotine patches in the RPBS schedule.
This decision, possibly the first move into a true preventative
health strategy by any government department, was based on offsetting
drug cost of the day against future medical and hospital expenditure.
Given that, in any general medical ward, up to 40% of patients are
there due to smoking related problems, DVA decided that the today
cost of a course of treatment to reduce smoking would be saved many
times over in five to ten years.
I know, immunisation campaigns work on the same principle, but we
were the first to apply it to a medicine.
The separation
of drug costs from the rest of health expenditure has, in effect,
made pharmacy a very easy target when governments look at the
burgeoning health expenditure. "Drug costs rise 20%"
makes a good headline, leading to letters and editorials demanding
that "the government do something to stop those greedy pharmacists".
Despite community pharmacists having almost no say in what doctors
prescribe they are the ones in the front line of cost minimisation
by government.
The number of times I've had to explain that increases in PBS
patient co-payment charges do NOT mean the pharmacist receives
more income. In these situations pharmacists tend to be the targets
of customer anger, making the profession's high Morgan poll rating
even more impressive.
How can the
profession meet the danger posed by the governments targeting
the PBS "bucket of money" when it is attempting to rein
in rising health costs?
One easy answer is to move away from reliance on payment for supply
of drugs towards payment for applying professional knowledge to
bring about the best outcomes from dug use.
I said the answer was easy, I didn't actually say doing it was
easy, but such a move would mean that pharmacy, to some extent,
would become master of its own destiny.
Medication management, although it might be considered to be merely
the current buzz phrase, is, at last, a means whereby pharmacy
insulate itself from budget induced danger.
We are, as a profession, strategically placed to become major
players in the never-ending search for cost effective health care.
Results from numerous studies are appearing in the medical press
showing that interventions by, and professional input from pharmacists,
can improve health outcomes and reduce costs.
The proof is out there - appropriate application of pharmaceutical
knowledge is cost effective.
Finally, dear colleagues, the pharmacist may be able to get out
from behind the computer screen to apply his/her wealth of experience
and actually get paid for it.
A brave new world, perhaps?
I can but dream.
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KEN STAFFORD