BY CHIA CHU HANG

To many , pharmacists are seen as individuals who merely dispense medicine behind a counter . While this perception isn ’ t entirely inaccurate , pharmacists are far more capable than commonly assumed , and this is not lost on the public .

As Saw et al . ( 2015 ) stated , although many Malaysian healthcare consumers surveyed were unaware of the specific areas in which pharmacists are trained , they felt pharmacists can play a greater role in our healthcare system .

A pharmacist ’ s role is not solely to dispense medicine . They offer advice on doctors ’ prescriptions , administer vaccines , adjust medication dosages , treat minor ailments that do not require a doctor ’ s diagnosis , and provide information about supplements .

Most importantly , pharmacists serve as an essential information gateway for patients seeking to understand their medication .

Although people may not fully grasp the pharmacist ’ s role , they are generally supportive and believe in pharmacists ’ greater potential , as summarised by Saw et al . ( 2015 ) and Ng et al . ( 2020 ). Notably , Loo et al .( 2019 ) reported that 86.7 per cent of Malaysians surveyed believe pharmacists have superior knowledge about medication compared to physicians .

Community pharmacists are integral healthcare providers within their communities . As Loh , Chua and Karuppannan ( 2021 ) highlighted , nearly all surveyed community pharmacists ( 99.5 per cent ) offer health screening and monitoring services . However , they encounter barriers in fully executing their duties , with the lack of dispensing separation identified as a primary obstacle ( Selvaraj , Redzuan & Hatah , 2020 ; Loh et al ., 2021 ).

DISPENSING SEPARATION

Dispensing separation divides the prescribing and dispensing process between doctors and pharmacists – doctors solely prescribe medication , while patients must go to a pharmacist to obtain their prescribed medication . This system functions as a check and balance , preventing doctors from overprescribing or unnecessarily prescribing medications , as pharmacists , being separate entities , oversee the dispensing process .

In Malaysia , doctors can both , prescribe and dispense medication depending on their workplace . Currently , only public hospitals and health clinics are mandated to implement dispensing separation , while private institutions are exempt .

Doctors dispensing medication have led to serious issues . According to the report , pharmaceutical companies have paid billions of dollars to doctors

for consulting , meals , and promotional talks , leading to higher volumes of drug prescriptions from these companies .

In the Malaysian context , a respondent in Saw et al .’ s ( 2015 ) study mentioned that , based on their experience , consulted general practitioners ( GPs ) would occasionally prescribe unnecessary medication .

Another recent study in Malaysia by Kabir et al . ( 2021 ) revealed a significant positive relationship between sales promotions and the prescribing behaviour of Malaysian physicians . Those promotions even ranged from low-value gifts such as pens or mugs to high-value gifts like laptops or sponsorship to local and international conferences .

Dispensing separation is a crucial safeguard exactly against such scenarios , deterring unscrupulous doctors from overprescribing medication for financial gains . The mandatory implementation of dispensing separation across Malaysia would greatly empower community pharmacists and facilitate their enhanced contribution to community well-being .

Furthermore , pharmacists are not the sole proponents of the view that dispensing separation can improve our healthcare system ; the Malaysian general public shares this sentiment . While Loo et al . ( 2019 ) reported that only 52.5 per cent of respondents favoured the implementation of dispensing separation , a 2021 research by Ghani , Kamaruddin , and Mokhtar found that 66.5 per cent of their respondents supported it , with 29.5 per cent remaining neutral .

However , dispensing separation also raises its own concerns .

CHALLENGES AHEAD

Implementing dispensing separation would increase the viability of community pharmacies . A 2016 report highlighted that some pharmacists struggle financially , greatly relying on sales of non-medical items . Allowing them to dispense prescription-only controlled drugs would undoubtedly boost their income .

However , the same argument applies to private GPs who own clinics . According to a 2014 report , since the Private Healthcare

Facilities and Services Act 1998 ( Act 586 ) has capped GP consultation fees at RM10 to RM35 , medication sales serve as their primary source of revenue .

Mandating dispensing separation risks a widespread decline in private clinics , which would impact public health as patients flock to public hospitals and clinics .

Dispensing separation also raises concerns about the accessibility of community pharmacies in certain areas . Tew et al . ( 2021 ) noted that six districts lack a community pharmacy , two lack GP clinics , and 11 districts in East Malaysia lack access to both . Tew et al . ( 2021 ) also observed a significantly higher density of community pharmacies in urban areas compared to less populated ones , with Sabah facing a particularly concerning ratio of one pharmacy to 20,032 people .

Implementing dispensing separation without addressing this issue could have catastrophic consequences for people in areas with limited pharmacy access .

NAVIGATING THE CHALLENGES

To prevent mandatory dispensing separation from crippling the private healthcare industry and leaving people in areas with limited pharmacy access without medication , we must address these two concerns before proceeding .

Fortunately , we are not starting from scratch in dealing with these problems . To sustain private clinics post-dispensing separation , the government should consider reviewing the fees listed in Act 586 .

In December 2019 , the then government agreed to deregulate private GP consultation fees , but the change never materialised . In May 2023 , the MADANI government once again proposed restructuring consultation fees after Parliament approved the Health White Paper ( HWP ).

However , upon closer examination of the HWP , there was no mention of restructuring private GP consultation fees . Concerns exist regarding the deregulation of consultation fees , as there are fears that private GPs may overcharge for their services , making deregulation unsustainable for our healthcare system .

As for the lack of accessibility to pharmacies

in certain areas , a zoning system for community pharmacies could be the solution we need . In 2012 , the government was already exploring such a system to ensure a more even distribution of pharmacies between rural and urban areas . Unfortunately , there has been no follow-up on this initiative since then .

The Malaysia Pharmacists Society mentioned past efforts in Johor , which saw limited success , likely due to insufficient public support at the time . However , the landscape has evolved significantly since then .

A recent qualitative study shows that consumers are now cognisant of the uneven distribution of pharmacies between urban and rural areas , with some seeing zoning policy as a viable way to improve accessibility in rural areas ( Leong et at ., 2022 ).

Furthermore , Leong and Chong ( 2024 ) conducted a study from the perspective of community pharmacists , who also saw zoning policy as advantageous for improving the quality of healthcare services .

Coincidentally , both consumers and community pharmacists share concerns about the implementation of zoning policy , fearing the potential creation of monopolies in their areas . Both groups worry that once zoning occurs , the sole pharmacy in the area may increase prices or shorten operating hours due to limited competition .

Therefore , to address these concerns , community pharmacists propose zoning based on population size rather than area ( Leong & Chong , 2024 ). The government regulation on operating hours coupled with price control can mitigate the adverse effects of potential monopolies .

It is worth noting that community pharmacists who participated in Leong and Chong ’ s research also emphasised the necessity of dispensing separation for zoning policy to be effective .

The income gap between rural and urban areas remains wide , indicating much lower spending power in rural areas . Together with the rising cost of living , people are less likely to spend on products like health supplements , thereby reducing community pharmacy income .

Enforcing a zoning policy without dispensing separation would reduce the number of pharmacies in urban areas . However , due to the higher financial risk of operating in rural areas , few , if any , would establish businesses there .

If done right , dispensing separation has great potential to enhance the healthcare system and benefit a broader spectrum of people . However , addressing a few corresponding issues is crucial to prevent this well-intended policy from weakening our community healthcare system . - The HEALTH

Chia Chu Hang is a Research Assistant at EMIR Research , an independent think tank focused on strategic policy recommendations based on rigorous research .