THE government鈥檚 move to set prices of essential medicines and the cost of medical tests is welcome. The government on August 26 announced that a committee had been formed to set medicine prices. The setting of medicine prices and medical test costs, which vary widely, has long been a popular demand, as low- and fixed-income groups suffer the most because of exorbitant out-of-pocket health expenditure, among the highest in South Asia. The High Court on August 25 directed the government to set and publish minimum prices of lifesaving medicines. The court has further declared illegal a 1994 health ministry circular that had listed 117 medicines as essential and set prices only for them, thereby allowing drug manufacturers to set prices for all other medicines which the court found to be in violation of the Drug (Control) Ordinance 1982 and the Essential Commodities Act 1957. An earlier estimate shows that Bangladesh produces more than 5,300 registered brands of 450 generic drugs, resulting in about 8,300 forms across various dosages and strength.
Such a situation is worrying on several counts. It suggests that either the quality of components in certain drugs is compromised or of substandard quality or some manufacturers levy excessive prices on medicines to make windfall profits. If the quality is compromised, it questions the adequacy of quality oversight. If manufacturers are, however, able to set prices for drug products at will, it points to a free rein on the pharmaceutical market, which is unacceptable. Taken together, the propositions point to glaring regulatory failures. Similarly concerning are enormous differences in costs of medical tests across healthcare facilities and diagnostic centres. In many instances, patients are required to pay double or even triple the amount for similar tests carried out at different centres. Further compounding the problem is the collusion of physicians and private healthcare facilities and diagnostic centres. Physicians often prescribe unnecessary medical tests solely to obtain commissions from private facilities. An unregulated drug market and unethical medical practices are but two of the many problems that afflict the healthcare sector. The health sector reforms commission in its report submitted on May 5 highlighted such issues and put forward many reform proposals to improve the sector. Yet, the recommendations have largely been put on the back burner.
The authorities should, therefore, strictly regulate the pricing of medicines and costs of medical tests under a comprehensive framework that covers all drugs and all diagnostic procedures. They should also prioritise the implementation of health sector reforms. It is imperative that the authorities should identify, refine and devise ways to put into effect the recommendations that have been advanced.
