How some Asian nations handled dispensing split
By : Rina De SilvaNST, 23rd April 2008
KUALA LUMPUR: Dispensing of medicine by pharmacists and not doctors is not just a western practice. It is the norm in several Asian countries, including India, Korea, the Philippines and even Indonesia.
It became legal in Indonesia in 1964, the Philippines in 1969, India in 1988, and in South Korea in 2000.
It is common to find 24-hour pharmacies in these countries.
Besides 24-hour pharmacies, the Philippines' 72 public hospitals also render 24-hour pharmaceutical services, said Romeo L. Manalo, assistant secretary of the Office of Standard Pacific Affairs at the Philippines' Department of Health.
"The hospital pharmacies run on an eight-hour shift not only for the inpatients and outpatients but also for the general public," he said.
In Mumbai, India, there are at least twenty 24-hour pharmacies, said Subodh Priolkar, immediate past president of the Indian Pharmaceutical Association.
If the pharmacy is closed, the patients can purchase the prescribed medication from hospital pharmacies which are open 24 hours, he said.
There are about 1,000 government hospitals there, he added.
The only exception to the law is in the rural areas in India where clinics there would purchase medicines in bulk from pharmacies, he said.
The exception to the law is also allowed in rural areas in Indonesia, said Eka Suripto, the head of communications at the Indonesian Embassy here.
In big cities, where there are more than one pharmacy, each will take turns to operate 24 hours, he said.
Although the separation of functions is now a norm, the practice came with its share of problems initially in Indonesia and South Korea.
As doctors could not dispense their own medicine some started to acquire their own pharmacy and the pharmacists' role was reduced to merely following the orders of the owner, said Eka.
He said due to the increasing number of such cases, the government issued an additional regulation in 1988 which barred doctors and dentists from dispensing or preparing medicine, except injections.
In South Korea, the separation of functions was strongly opposed by physicians who were afraid of losing an income source, said Prof Dr Soonman Kwon, chairman of health policy and management department at the Seoul National University's School of Public Health.
"Following a wave of strikes, the government was forced to modify the reform package and to raise the doctor's consultation fees substantially to compensate for the physicians' income loss," he said.
Prior to the mandated separation of functions, both physicians and pharmacists were prescribing and dispensing medicine which resulted in the overuse and misuse of medicine, he added.
"After the separation of functions, pharmacists are not happier because they cannot prescribe anymore," he said.
In India, the separation of function made no difference to the doctors' consultation fee, said the spokesperson from the media division of the Indian High Commission here.
In private practice, the consultation fee of 50 to 200 rupees (about RM4.20 to RM16.50) remained the same.
Subodh said the separation of functions worked because only pharmacists have the knowledge and training to dispense medication and counsel patients on how to take the medication.
"In the event of possible effects of drug combination, pharmacists have the right to ask for a medical history," he said.
He added that doctors usually prescribe the best medication for the patient based on the patient's medical history.
There has been an improved therapeutic compliance in the Philippines as a result of the separation, said Manalo.
"Pharmacist as dispensers serve as the second technical person in contact with the public by providing the necessary information and counselling on drugs and other related matters," he said.
It is common to find 24-hour pharmacies in these countries.
Besides 24-hour pharmacies, the Philippines' 72 public hospitals also render 24-hour pharmaceutical services, said Romeo L. Manalo, assistant secretary of the Office of Standard Pacific Affairs at the Philippines' Department of Health.
"The hospital pharmacies run on an eight-hour shift not only for the inpatients and outpatients but also for the general public," he said.
If the pharmacy is closed, the patients can purchase the prescribed medication from hospital pharmacies which are open 24 hours, he said.
There are about 1,000 government hospitals there, he added.
The only exception to the law is in the rural areas in India where clinics there would purchase medicines in bulk from pharmacies, he said.
The exception to the law is also allowed in rural areas in Indonesia, said Eka Suripto, the head of communications at the Indonesian Embassy here.
In big cities, where there are more than one pharmacy, each will take turns to operate 24 hours, he said.
Although the separation of functions is now a norm, the practice came with its share of problems initially in Indonesia and South Korea.
As doctors could not dispense their own medicine some started to acquire their own pharmacy and the pharmacists' role was reduced to merely following the orders of the owner, said Eka.
He said due to the increasing number of such cases, the government issued an additional regulation in 1988 which barred doctors and dentists from dispensing or preparing medicine, except injections.
In South Korea, the separation of functions was strongly opposed by physicians who were afraid of losing an income source, said Prof Dr Soonman Kwon, chairman of health policy and management department at the Seoul National University's School of Public Health.
"Following a wave of strikes, the government was forced to modify the reform package and to raise the doctor's consultation fees substantially to compensate for the physicians' income loss," he said.
Prior to the mandated separation of functions, both physicians and pharmacists were prescribing and dispensing medicine which resulted in the overuse and misuse of medicine, he added.
"After the separation of functions, pharmacists are not happier because they cannot prescribe anymore," he said.
In India, the separation of function made no difference to the doctors' consultation fee, said the spokesperson from the media division of the Indian High Commission here.
In private practice, the consultation fee of 50 to 200 rupees (about RM4.20 to RM16.50) remained the same.
Subodh said the separation of functions worked because only pharmacists have the knowledge and training to dispense medication and counsel patients on how to take the medication.
"In the event of possible effects of drug combination, pharmacists have the right to ask for a medical history," he said.
He added that doctors usually prescribe the best medication for the patient based on the patient's medical history.
There has been an improved therapeutic compliance in the Philippines as a result of the separation, said Manalo.
"Pharmacist as dispensers serve as the second technical person in contact with the public by providing the necessary information and counselling on drugs and other related matters," he said.
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