..Information to Pharmacists
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    Your Monthly E-Magazine
    APRIL, 2003

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    KEN STAFFORD

    Consultant Pharmacist Perspective

    Buckets of Money!

    The March 2003 edition of the "Australian Pharmacist" contains an editorial by Jay Hooper, National President of PSA, entitled "A fragmented health system".
    In this, he writes about how the separation of different areas of health care raises a barrier to optimal health outcomes.
    Although the subject of this editorial has nothing whatsoever to do with the topic, as I read on my mind did one of those odd wanders into abstract concepts.
    This one returned me to an argument I've explored in conversations about pharmacy, the PBS and health costs.

    "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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