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WHAT MATTERS MOST: Wrong fee


Clyde Mascoll

WHAT MATTERS MOST: Wrong fee

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Since the introduction of a fee structure on medication provided by the Barbados Drug Service, I have been asking myself how Government arrived at the price ranges and the accompanying fees.
The fee structure simply does not make any economic sense and is not designed to achieve social equity among users.
If a patient buys one set of medication for $2, he pays $5 in fees and if he leaves the counter and turns around to add another set of medication for $11, he pays $7. Therefore, someone may spend $13 on medication and pay $12 in fees.
On the other hand, another individual may purchase one set of medication for $40 and pay the same $12 in fees.
It is also possible to buy medication for $10 and spend $15 when the fee is added. Another individual may pay $10 and one cent for medication and end up spending $17 and one cent. Just an additional cent in medication increases the bill by $2.
From the above examples, it is evident that the reform does not benefit those persons at the lower end of the drug market.
The fee structure gets worse when it imposes a percentage charge on medication over $40. This is because the notion of a dispensing fee suggests that the fee is on the cost of the transaction and not the cost of the drug.
When the percentage is imposed on the cost of the drug any concept of equity is taken out of the equation as the demand for a drug is not seen in the same vein as the demand for a typical commodity. The use of the percentage puts a greater burden on the person the higher the cost of the drug which has nothing to do with income; it has to do with illness. A poor man is no less ill than a rich man!
 Above and beyond the price charged on a commodity, it is normal to expect the consumption of a commodity to bear some relation to the consumer’s income. Therefore, if an individual has to ask the price of a Mercedes Benz, then that individual is at the wrong dealership.
The consumption of drugs does not carry such a feature as illness is not confined to anyone on the basis of income, that is, it is present among both the rich and the poor.
The decision to have a fee structure on the basis of the cost of the drug is therefore baffling.
Furthermore, to suggest that once a public sector pharmacy is used the fee is not applicable is not only baffling but deceitful, since it is impossible for the public sector pharmacies to dispense all of the drugs – they only now do ten per cent.
The imposition of the new dispensing fee affects the issue of fairness.
The original proposal to impose on beneficiaries using private pharmacies a $5 per prescription item for drugs under $40 and a $10 per prescription item for drugs over $40 was more in concert with the notion of fairness.
The desperation of this Government for money to help solve a self-imposed fiscal crisis is responsible for the failure of the new dispensing fee to reflect greater concerns for the peculiarities of the economic and social issues associated with the consumption of medication.
There is no doubt that the cost of delivering the Barbados Drug Service has to be addressed but to put the emphasis on the dispensing fee without consideration for its impact on the poor and elderly is simply once again wrong-headed policy.
When will this administration learn that public policy must have first and foremost a human face and must not be driven by market forces alone?    

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