ONE OF the first commitments made by Minister for Health James Reilly on assuming office was to abolish prescription charges. The 50 cent per item monthly charge for medicines dispensed under the medical card scheme was introduced in the 2010 budget by his predecessor and was criticised by Dr Reilly as a move that targeted those with the least ability to pay.
However, it has been suggested that a prescription charge may act as a deterrent to medicine wastage. A GP writing to this newspaper described a recent visit to an older person where he was shown a drawer with 10 unopened tubes of skin cream valued at €1,000. The skin treatment was no longer needed but it took the imposition of the prescription charge for the patient to ask her doctor to stop prescribing the cream.
Community pharmacists and GPs routinely come across such medicine “stashes” in people’s homes. But is a prescription charge a reasonable mechanism to deal with the problem? Prescription charges were part of the UK National Health Service for many years. Scotland’s decision to get rid of the charge from next month means that only England will retain it. The 2011 charge will be £7.40 (€8.50) per prescription. But there are exemptions: it is estimated that about 90 per cent of prescriptions do not attract the payment on the basis of age and a somewhat arbitrary list of chronic medical conditions. Charges of inequity have been levelled at the system. But supporters claim the charge helps clarify the public understanding of the cost and value of drugs.
Rather than focusing exclusively on a prescription charge, perhaps the issue that requires attention is compliance with treatment. A 2002 Royal Pharmaceutical Society report found that some eight in 10 people were not taking their medicines as directed. This may be due, in part, to ongoing paternalism in the doctor-patient relationship, with many people feeling that prescribing is something that is done to them and not with them. There has been a move to concordance: where a meeting of minds is encouraged as to why a particular intervention may be necessary and away from compliance with its implication that patients must automatically do what they are told.
Our health system must offer doctors and patients more time to achieve concordance. The introduction of universal healthcare offers an opportunity to incentivise this shift. On balance, Dr Reilly is correct to abolish the prescription charge. But he must prioritise other means of tackling waste of unused medications.