Abstract
The implementation of National Health Insurance (NHIS; or Jaminan Kesehatan Nasional/JKN)’s policy, increasing patient access to medicine while keeping its budget under tight control, has the potentiality to result in compromising the safety and efficacy of the medicine. Budget constraint and the existing asymmetry information in terms of quality and price of medicines could lead to a moral hazard situation where pharmaceutical companies may produce substandard and falsified medicines to secure their profit. The result of this research using logistic regression analysis showed that despite previous assumptions, medicines included in JKN list are actually having lower probability of falsified or substandard compared to their counterparts, non-JKN medicines. In terms of the relation between price and quality of the medicines, the probability of falsified or substandard medicines increases up to a price level where for the poor qualified medicines does not have the ability to copy the original medicines while still making profit out of it. As a result, this research recommends full implementation of JKN to include all essential medicines into its list to avoid asymmetry information and maintain medicines quality. JKN also needs to have a price-differentiation policy which allows pharmaceutical companies to maintain quality of their medicines, even to innovate for a better one, while still maintaining a good profit and their ability to compete in the JKN era.
Bahasa Abstract
Penerapan kebijakan JKN untuk menjamin akses masyarakat terhadap obat dengan pengendalian biaya yang ketat berpotensi terhadap terjadinya kompromi kualitas dan keamanan obat. Pembatasan harga obat dan adanya asimetris informasi terkait kualitas dan harga obat dapat mendorong moral hazard produsen memproduksi obat substandar dan palsu untuk mempertahankan keuntungan. Hasil analisis melalui regresi logistik menunjukkan bahwa peluang suatu obat JKN tergolong tidak memenuhi syarat lebih rendah daripada peluang suatu obat non-JKN. Seiring dengan kenaikan harga satuan obat, peluang suatu obat tergolong tidak memenuhi syarat meningkat, hingga pada tingkat harga satuan tertentu yang tidak memungkinkan lagi obat substandar dan palsu dijual dengan harga kompetitif, peluang tersebut mulai menurun. Penelitian ini merekomendasikan implementasi penuh sistem JKN sebagai upaya mengatasi asimetris informasi harga dan kualitas obat, dengan memberlakukan diferensiasi harga sebagai suatu insentif bagi industri farmasi mempertahankan mutu dan ikut berkompetisi dalam penyediaan obat JKN.
References
Agustina, R., Dartanto, T., Sitompul, R., Susiloretni, K. A., Suparmi, et al. (2019). Universal health coverage in Indonesia: concept, progress, and challenges. The Lancet, 393(0), 75–102. https://doi.org/10.1016/S0140-6736(18)31647-7
Akerlof, G. A. (1970). The Market for "Lemons ": Quality Uncertainty and the Market Mechanism. The Quarterly Journal of Economics, 84(3), 488–500. Retrieved from https://www.jstor.org/stable/1879431
Alfadl, A. A., Hassali, M. A., & Ibrahim, M. I. M. (2013). Counterfeit drug demand : Perceptions of policy makers and community pharmacists in Sudan. Research in Social and Administrative Pharmacy, 9(3), 302–310. https://doi.org/10.1016/j.sapharm.2012.05.002
Baert, B., & De Spiegeleer, B. (2010). Quality analytics of internet pharmaceuticals. Analytical and Bioanalytical Chemistry, 398(1), 125–136. https://doi.org/10.1007/s00216-010-3912-4
Baltzer, K. (2012). Standards vs. labels with imperfect competition and asymmetric information. Economics Letters, 114(1), 61–63. https://doi.org/10.1016/j.econlet.2011.09.032
Bate, R., Jin, G. Z., & Mathur, A. (2011). Does price reveal poor-quality drugs? Evidence from 17 countries. Journal of Health Economics, 30(6), 1150–1163. https://doi.org/10.1016/j.jhealeco.2011.08.006
Bate, R., Jin, G. Z., & Mathur, A. (2012). Counterfeit or Substandard? Assessing Price and Non-Price Signals of Drug Quality. National Bureau of Economic Research Working Paper Series, No. 18073(4), 687–711. https://doi.org/10.3386/w18073
Becker, G. S. (1968). Crime and Punishment : An Economic Approach. Journal of Political Economy, 76(2), 169–217. Retrieved from https://www.jstor.org/stable/1830482
Fink, C., Maskus, K. E., & Qian, Y. (2016). The economic effects of counterfeiting and piracy: A review and implications for developing countries. World Bank Research Observer, 31(1), 1–28. https://doi.org/10.1093/wbro/lkv010
Grossman, G. M., & Shapiro, C. (1986). Counterfeit-Product Trade. American Economic Review, 78(1), 59–75. https://doi.org/10.2307/1814698
Hamilton, W. L., Doyle, C., Halliwell-Ewen, M., & Lambert, G. (2016). Public health interventions to protect against falsified medicines: A systematic review of international, national and local policies. Health Policy and Planning, 31(10), 1448–1466. https://doi.org/10.1093/heapol/czw062
Johnston, A., & Holt, D. W. (2014). Substandard drugs: A potential crisis for public health. British Journal of Clinical Pharmacology, 78(2), 218–243. https://doi.org/10.1111/bcp.12298
Kovacs, S., Hawes, S. E., Maley, S. N., Mosites, E., Wong, L., & Stergachis, A. (2014). Technologies for detecting falsified and substandard drugs in low and middle-income countries. PLoS ONE, 9(3). https://doi.org/10.1371/journal.pone.0090601
Leonard, D. K., Bloom, G., Hanson, K., O’Farrell, J., & Spicer, N. (2013). Institutional Solutions to the Asymmetric Information Problem in Health and Development Services for the Poor. World Development, 48, 71–87. https://doi.org/10.1016/j.worlddev.2013.04.003
Lima, F. R. P. de, Da Silva, A. L., Godinho Filho, M., & Dias, E. M. (2018). Systematic review: resilience enablers to combat counterfeit medicines. Supply Chain Management: An International Journal, 23(2), 117–135. https://doi.org/10.1108/SCM-04-2017-0155
Lybeker, K. M. (2008). Keeping it real: anticounterfeiting strategies in the pharmaceutical industry. Managerial and Decision Economics, 29, 389–405. https://doi.org/10.1002/mde
Mackey, T. K., Liang, B. A., York, P., & Kubic, T. (2015). Counterfeit Drug Penetration into Global Legitimate Medicine Supply Chains: A Global Assessment. American Journal of Tropical Medicine and Hygiene, 92(Suppl 6), 59–67. https://doi.org/10.4269/aj
Nagurney, A., Li, D., & Nagurney, L. S. (2014). Spatial price equilibrium with information asymmetry in quality and minimum quality standards. International Journal of Production Economics, 158, 300–313. https://doi.org/10.1016/j.ijpe.2014.08.013
Norum, P. S., & Cuno, A. (2011). Analysis of the demand for counterfeit goods. Journal of Fashion Marketing and Management, 15(1), 27–40. https://doi.org/10.1108/13612021111112322
Organisation for Economic Co-operation and Development OECD. (2008). The Economic Impact of Counterfeiting and Piracy. Paris: OECD Publishing. https://doi.org/10.1787/9789264045521-en
Ozawa, S., Evans, D. R., Bessias, S., Haynie, D. G., Yemeke, T. T., Laing, S. K., & Herrington, J. E. (2018). Prevalence and Estimated Economic Burden of Substandard and Falsified Medicines in Low- and Middle-Income Countries. JAMA Network Open, 1(4), e181662. https://doi.org/10.1001/jamanetworkopen.2018.1662
Petersen, A., Held, N., & Heide, L. (2017). Surveillance for falsified and substandard medicines in Africa and Asia by local organizations using the low-cost GPHF Minilab. PLoS ONE, 12(9), 1–23. https://doi.org/10.1371/journal.pone.0184165
Pisani, E., Nistor, A.-L., Hasnida, A., Parmaksiz, K., Xu, J., & Kok, M. O. (2019). Identifying market risk for substandard and falsified medicines: an analytic framework based on qualitative research in China, Indonesia, Turkey and Romania. Wellcome Open Research, 4, 70–94. https://doi.org/10.12688/wellcomeopenres.15236.1
Rahman, M. S., Yoshida, N., Tsuboi, H., Tomizu, N., Endo, J., Miyu, O., … Kimura, K. (2018). The health consequences of falsified medicines- A study of the published literature. Tropical Medicine and International Health, 23(12), 1294–1303. https://doi.org/10.1111/tmi.13161
Rebiere, H., Guinot, P., Chauvey, D., & Brenier, C. (2017). Fighting falsified medicines: The analytical approach. Journal of Pharmaceutical and Biomedical Analysis, 142, 286–306. https://doi.org/10.1016/j.jpba.2017.05.010
Swami, V., Chamorro-Premuzic, T., & Furnham, A. (2009). Faking it: Personality and individual difference predictors of willingness to buy counterfeit goods. Journal of Socio-Economics, 38(5), 820–825. https://doi.org/10.1016/j.socec.2009.03.014
Venhuis, B. J., Oostlander, A. E., Giorgio, D. Di, Mosimann, R., & Plessis, I. (2018). Series Drug safety in oncology 3 Oncology drugs in the crosshairs of pharmaceutical crime. Lancet Oncology, 19(4), e209–e217. https://doi.org/10.1016/S1470-2045(18)30101-3
Wasir, R., Irawati, S., Makady, A., Postma, M., Goettsch, W., Buskens, E., & Feenstra1, T. (2019). Use of medicine pricing and reimbursement policies for universal health coverage in Indonesia. PLoS ONE, 14(2), 1–20. https://doi.org/10.1371/journal.pone.0212328
WHO. (2017a). A study on the public health and socioeconomic impact of substandard and falsified medical products. Geneva.
WHO. (2017b). WHO Global Surveillance and Monitoring System for Substandard and Falsified Medical Product. Geneva.
WHO. (2017c). WHO Member State Mechanism on Substandard/Spurious/Falsely-Labelled/Falsified/Counterfeit (SSFFC) Medical Products. Seventieth World Health Assembly, A70/23: 33-36. Retrieved from http://www.who.int/medicines/regulation/ssffc/A70_23-en1.pdf?ua=1
Winda, S. (Komisi P. K. (2018). Formularium Nasional (FORNAS) dan e-catalogue obat sebagai upaya pencegahan korupsi dalam tata kelola obat Jaminan Kesehatan Nasional (JKN). Jurnal Integritas, 4 Nomor 2, 177–206.
Wirtz, V. J., Hogerzeil, H. V, Gray, A. L., Bigdeli, M., Joncheere, et al. (2017). Essential medicines for universal health coverage. Kazan Medical Journal, 389(1), 403–476. https://doi.org/10.17816/kmj2019-4
Yusuf, P. W., & Komariah, N. (2017). Seputar Pengalaman Penduduk Miskin Pedesaan Dalam Mencari, Menggunakan, dan Mendokumentasikan Informasi Kesehatan. Lentera Pustaka, 3(1), 1–18. Retrieved from http://ejournal.undip.ac.id/index.php/lpustaka
Recommended Citation
Agusriana, Rafika and Wikarya, Uka
(2021)
"Pengaruh Kebijakan Harga Obat terhadap Peluang Peredaran Obat Substandar dan Palsu,"
Jurnal Kebijakan Ekonomi: Vol. 16:
No.
1, Article 10.
Available at:
https://scholarhub.ui.ac.id/jke/vol16/iss1/10
Included in
Economics Commons, Public Affairs, Public Policy and Public Administration Commons, Urban Studies and Planning Commons