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Vietnam medical ethics: A bitter
pill
By Tran Dinh Thanh Lam
HO CHI MINH CITY - That doctors prescribe
virtually the same drugs, some locally made and some
imported, at vastly different prices is a reality many
Vietnamese have been coming to terms with since the
early 1990s when economic reforms, or doi moi,
were first phased into this communist country.
Vietnam's socialist character has played a key
role in lifting the nation's quality of health standards
as a developing country. But economic liberalization has
brought changes, including the deregulation of the drug
industry, the effect of which worries some people.
The big difference in costs is due to the fact
that the first doctor prescribed imported medicines that
can cost many times more than local ones, even though
their quality is comparable.
Of particular
concern are reports that doctors are prescribing
expensive drugs, not out of any great concern for the
patient but to earn commissions from pharmaceutical
corporations for pushing their product lines.
"Everybody knows that doctors [working for
state-run hospitals] are generally poorly paid [about
US$100 per month]. That is why asking some doctors to
prescribe your products is not a very difficult thing,"
said pharmacist Dinh Ba Ai, head of the pharmaceutical
department at the Union of Private Companies in Vietnam.
Ai was addressing an August seminar in Ho Chi
Minh City that reviewed the price situation of imported
medicine in the local market.
Vietnam relies
heavily on imported medicines and more than 230
pharmaceutical companies from 28 countries have been
licensed to operate in the country. India, France and
Germany have the largest number of operations.
There are currently 15 wholly foreign-owned and
eight joint-venture projects capitalized at a total of
$186 million, but so far only two of these projects have
started to manufacture drugs for the local market.
Although the Ministry of Health has repeatedly
called for hospitals and health centers to stock locally
made pharmaceuticals, the reality is that the majority
of firms producing drugs locally do not use advanced
technology and have limited production lines, leaving
imported drugs to take up the slack.
But due to
fierce international competition, foreign pharmaceutical
companies are using all kinds of tactics to increase
their share of the Vietnamese market.
These,
industry experts say, include trying to lure doctors
through gifts, special offers and monthly commissions to
push certain product lines and get the doctors to use
them instead of competitors' medicines.
"The
practice is becoming an illness that hits more and more
physicians. Commission rates [are getting] higher and
higher too. From 10 percent in 1980, it doubled in 1990.
Now, if you offer a commission lower that 30 percent,
you will never be able to ask doctors to prescribe your
products," Ai told the seminar.
Offers of trips
abroad, another tactic used by the big firms, rarely
fail to win a physician's heart, critics say. Doctors
are often invited to visit pharmaceutical plants or to
attend technical seminars abroad, but these trips are in
fact paid holidays devised to reward doctors for their
cooperation, experts at the seminar said.
"This
is a very successful tactic. Once your travels have been
paid from A to Z by the firm, it is rather difficult to
refuse their demands," Ai said.
Dr Do Hoang
Giao, deputy director of the People's Hospital of Gia
Dinh in Ho Chi Minh City, explained that the reason
behind doctor's high commissions was "the floating
prices of imported medicine".
"Health
authorities should have set a price framework for each
category of imported medicine before allowing them to be
sold on the market," Giao said.
To date, the
government has yet to nominate a body whose
responsibility it is to set the price of imported
medicines.
According to figures released at the
seminar, pharmaceutical firms increase the prices of
imported drugs by 100-300 percent before putting them on
the market. This means that Vietnamese people pay much
more than their counterparts in the developed world for
prescription drugs.
As a result of this
unchecked pricing, experts say the Vietnamese public was
"robbed" of more than VND3 trillion ($195 million) in
1999. The sum does not include the 5 or 10 percent
surplus taken by wholesalers of drugs, and the 40 or 50
percent by retailers.
In short, an imported drug
is usually sold at thrice its initial price in this
country.
According to a Health Ministry
instruction in August, "Doctors must prescribe drugs
according to the patient's illness and to his or her
economic situation. They are not allowed to overuse
expensive imports, too costly for poor patients."
The problem, however, is how to find the bad
apples among the doctors. Giao says it is virtually
impossible to control what a doctor prescribes.
While it is easy to fault a doctor for
prescribing the wrong drug, it is far more difficult to
blame a physician for prescribing an expensive drug,
especially when there are no local substitutes.
"It is only when state control becomes more
effective that pharmaceutical companies and doctors will
not be able to cooperate to increase the prices of
imported drugs," Giao said.
(Inter Press
Service)
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