Are quality medicines affordable? Evidence from a large survey of medicine price and quality in Indonesia
Background Since Indonesia implemented one of the world’s largest single-payer health insurance schemes in 2014, the price of many common medicines has fallen dramatically. Industry groups warn unsustainably low prices threaten quality, while the government says medicines remain overpriced. We inves...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2025-05-01
|
| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/10/5/e015416.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| Summary: | Background Since Indonesia implemented one of the world’s largest single-payer health insurance schemes in 2014, the price of many common medicines has fallen dramatically. Industry groups warn unsustainably low prices threaten quality, while the government says medicines remain overpriced. We investigate the relationship between the price and quality of essential medicines and the affordability of medicines paid for out of pocket.Methods We bought over 1000 samples of five common prescription medicines—allopurinol, amlodipine, amoxicillin, cefixime and dexamethasone—online and from randomly selected pharmacies and health facilities in four regions across Indonesia. We recorded the price paid and tested samples for quality using high-performance liquid chromatography. We compared prices with the median and lowest prices for each medicine, tested for correlation between quality and price, and calculated affordability compared with the district minimum wage.Results Medicines available in the public procurement system were less likely to fail quality testing than other brands/varieties (4.2% vs 8.3%) but the difference was not statistically significant (p=0.086). There was no other relationship between quality and price, or branded status. Branded generic medicines sold at a large variety of price points, from 0.3 to 18.6 times the median price for the medicine and dose (IQR: 0.9–5.0, median 1.4). Unbranded generics traded in a narrower range (range 0.1–2.6; IQR 0.6–1.0, median 0.8). Medicines were most expensive in the region with the lowest wages, but even there, medicines selling at the 25th percentile of available prices cost a maximum of 0.7% of 1 day’s wage for a course.Conclusion In every study district, we found that Indonesian patients working at the minimum wage could access affordable, quality-assured versions of all studied essential medicines. More expensive brands were also widely available, but there was no relationship between price and quality. |
|---|---|
| ISSN: | 2059-7908 |