Saturday, 9 February 2013

Take 3: Reimbursement for medicine out of stock

If you are confused about what actually the PN are promising in this regard don't blame yourself.   On the contrary it shows that your brain is working normally.  The confusion lies within the PN.

This is what pledge 31 (ii) of their manifesto says:

Aktar medicini ghalik meta jkollok bzonnhom - Fejn jirrizulta li medicina partikolari li int intitolat ghaliha tkun our of stock, il-Gvern ser jaghti lura kumpens lil min ikun xtraha privatament ghaliex ikollu bzonnha urgenti, skont prezzijijiet stabbiliti.
A literal translation is:

More medicines for you when you need them - Where it results that a particular medicine for which you are entitled goes out of stock, government will compensate whoever buys it privately because they need it urgently, according to established prices.
This is unambiguous pledge to refund the cost to whoever is constrained to buy the medicine privately because it goes out of stock in the government medicine distribution system.

So immediately the question arose how much will be the cost of government inefficiency in the medicine  procurement system?   This is what I wrote on this blog on 25 .01.2013:

And how on earth are the PN going to cost the pledge that they will refund the cost of free medicine when this is not available from government through the POYC or its central supply points.
One has to bear in mind that when government provides free medicine through its systems the procurement cost is often a fraction of the retail price of such products.   Often it is 25% or less.   
So if I am entitled to a medicine the procurement cost of which for government in the normal course of events is ten Euro,  its retail price is often forty Euro.    If government has to pay free medicine that goes out of stock at its retail price it would have to pay forty Euro when normally it would pay ten Euro.
The more inefficient the procurement system gets the more expensive it would become for taxpayers to bear the cost burden for the provision of free medicine.

Government was caught on the wrong foot and immediately it was constrained to clarify that the refund would not be for the full retail price but for established prices reflecting the procurement cost to government.

In so saying the government was admitting that through such a scheme consumers would be forced to pay a substantial price for medicine they are entitled to free of charge and it would practically give every incentive to government to avoid addressing its inefficient procurement system, which at the end of the day is the source of the problem.

Again government was caught on the wrong foot so it had to issue a take 3 clarification that:

Patients will not pay anything when they have to get medicines from private pharmacies because they go out of stock in government dispensaries, the prime minister said this afternoon.
He explained that the medicines would be paid for by the government at an established price, but the transaction would be made with the pharmacies, not the individual patients.

Come off it!   The pledge speaks clearly of a refund to who is constrained to buy the medicine privately and government is having to re-write the pledge on the trot.   And would pharmacies accept to give medicines free of charge to patients, medicines they would have bought at wholesale prices, and then wait who knows how many months to get reimbursed by government at established prices reflecting government's procurement costs which in bulk public tenders are invariably below the wholesale price for such medicine?    And this without entering into the merits that pharmacies generally carry patented medicine whereas government rightly dishes out generics.

And Take 3 is even in the PN campaign logo.  Whereas the PL has one battle-cry :


the PN has three:

Futur fis-Sod; 
Qabza ohra ta' kwalita'

Problem for the PN is that whereas they are used to Take 3 this time they need Take 4  in terms of election victories.   Take 3 was a very close shave.  Take 4 is......

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