Thailand - Thai business heads give the government passing marks

BANGKOK   Thai Prime Minister Prayuth Chan-ocha may not be popular with human rights groups and democracy activists, but he has earned a certain respect from local and expatriate business executives.

"Whenever I meet him he tells me, 'Don't complain! Tell me how,'" said Stanley Kang, chairman of the Joint Foreign Chambers of Commerce in Thailand. "We told the government that if there is no investment in infrastructure, there is no foreign investment. If he wants to stay in power, he has to make sure it's happening. He cannot sit in that post and do nothing."

Thailand's economy has been flaccid since the military coup two years ago, notching up just 0.9% annual growth in 2014 and 2.5% last year. The World Bank has forecast 2.5% growth in 2016, below the 3.1% predicted by the Bank of Thailand, which recently lowered its forecast due to weakening exports. Exports rose a scant 0.4% in the first five months of 2016 from the same period in 2015, and the outlook remains poor. Nonetheless, the government recently set a target of 5% annual growth between 2017 and 2021.

"Earlier on we were expecting 3% growth this year, now [after the U.K.'s Brexit decision] we are looking at 2.8%," said Nalin Chutchotitham, chief economist at HSBC Thailand. "The political uncertainty in Europe and uncertainty in regard to trade policies could cause delays in some export orders around the world, so ... Thailand could be impacted indirectly."

Thailand's export-led economy -- exports amount to 65% of gross domestic product -- has been faltering due primarily to slowing global demand, especially in China. Thailand is also becoming less competitive in some sectors such as electronics, with foreign investors shifting to Vietnam, where labor costs are lower. A decade of political upheaval -- with two coups and occasionally violent street protests -- has also taken its toll.

The political conflict centered on controversial former Prime Minister Thaksin Shinawatra, who first came to power in 2001 and then again in 2005, winning strong election mandates. Part of Thaksin's appeal was his ability to get things done, thanks to his monopoly on power -- sometimes with a strong whiff of corruption. Bangkok's Suvarnabhumi Airport, the last Thai megaproject under Thaksin, was pushed through, opening days before he was overthrown in 2006.

The 2006 coup spawned a military-led government dubbed the "Tom and Jerry" cabinet because of its obsession with chasing down former Prime Minister Thaksin Shinawatra, cat-and-mouse style, turfing out acolytes from the administration and undoing some of his more populist policies. By contrast, the Prayuth regime has been more focused on policies to keep the private sector and foreign investors happy.

"The government is very conscious of trying to make it easier to do business here given the increasingly competitive environment in the region for foreign direct investment," said Darren Buckley, country head of U.S. bank Citi for Thailand, Cambodia, Myanmar and Laos and chairman of the Association of International Banks in Thailand. "Incentives for regional headquarters, relaxation of some of the visa rules, a focus on digitization as a national priority and enhanced anti-corruption measures are steps in the right direction, with more still to do."

STIMULUS EFFORTS   Prayuth's first economic czar, former Deputy Prime Minister Pridiyathorn Devakula, helped launch Thailand on the path toward the digital economy and push through a new tax package for international headquarters and international trade centers to compete with Singapore and Hong Kong. After Pridiyathorn's departure a year ago, Prayuth's new czar, Deputy Prime Minister Somkid Jatusripitak, has primed the pump with long-term public investment plans and short-term consumption led stimulus packages.

Somkid has adjusted tax incentives for 10 industrial clusters, each focusing on a new industry -- next-generation cars, smart electronics, upscale medical tourism, agriculture and biotechnology, food, industrial robotics, logistics and aviation, biofuels and biochemicals, digital products and medical services. The clusters will be located in the Eastern Economic Corridor along Thailand's east coast industrial belt. The Thai cabinet has approved an initial budget of 300 billion baht ($8.59 billion) for related infrastructure projects.

Economists say that for Thailand to succeed in the new value-added sectors, it will need a value-added labor force, which the country's abysmal education system does not seem ready to provide. "But it's a good start," Nalin said. "I think it's like a wake-up call to Thailand. In the end, it is productivity and innovation that can help us grow, not cheap labor or adding on machinery."

The EEC might boost Thailand's competitiveness in the long term, but in the short-term Prayuth faces a formidable challenge keeping annual growth at 3% or above. This year, Thailand's twin engines for growth are tourism and public spending. After some weak periods, tourism is performing reasonably well. In the first five months, the country drew some 14.2 million foreign tourists, up 12.9% year-on-year, with Chinese tourists driving the numbers. The tourism ministry has targeted a total of 32 million visitors this year. But officials know that mass tourism is hardly a sustainable economic engine in an era where one terrorist incident can send shock waves throughout the entire sector.

The private sector is particularly keen to see whether the government can push its ambitious plans for 20 fast- tracked infrastructure projects -- roads, mass transit lines in Bangkok, dual track rails and some more dubious plans for high-speed train lines -- by next year, when an election is planned.

Cabinet approvals will be sped up by the use of Article 44 under the interim constitution, which provides Prayuth absolute power to fast-forward projects by bypassing bureaucratic requirements such as thorough environmental impact assessments, before a referendum is held on Aug. 7 over a new charter. The projects would eventually pump about 1.6 trillion baht into the economy.

"They need to do something to show to the investors -- and to the public too -- with the referendum coming up," said Charl Kengchon, managing director of the Kasikorn Research Center. "I think they are doing the right thing, but it will take more than infrastructure, more than the EEC. It takes other ingredients like labor, education and competition issues."

Despite the increased public spending, which was up an annual 30% last year and will grow 11.5% this year, consumer confidence surveys have consistently found that Thais remain concerned about the future. Household debt remains perilously high at 82% of GDP, and manufacturers are not hiring because of excess capacity. In early July, Toyota Motors Thailand, one of the country's biggest employers, launched its first-ever voluntary redundancy program, aimed at shedding 10% of its regular workforce. Many other automakers in Thailand have been quietly sacking part-time workers, as their factories are operating at only 60-70% capacity.

To boost Thailand's manufacturing and exports, the global economy needs to recover, which Prayuth cannot accomplish even with Article 44. But he does seem determined to push through his other plans for the economy, including a new land and building tax that would have been hard for an elected government to achieve.

"Regardless of the outcome of the referendum, the current government can carry on with their projects and initiatives because they are going to ensure that they have a mechanism built into the new constitution to do so," said Kasikorn's Charl. "I think they are going to carry on with this legacy no matter which constitution they use."

Peter Janssen

nikkei

You can find older posts regarding ASEAN politics and economics news at SBC blog, and older posts regarding health and healthcare at IIMS blog. I thank you.

Americans Spend Big On Non-Conventional Health Care Services

Complementary medicine, medical tourism contribute to increase in personal health care expenses.

Americans’ out-of-pocket health care costs are rising, but not all of it is due to rising health insurance co-payments and deductibles. Two new reports indicate that people liberally spend their own money on non-conventional sources of medical care.

The National Center for Health Statistics said an estimated 59.3 million people age 4 or older spent $30.2 billion out-of-pocket in 2012 on complementary and alternative medicine, or CAM, services. 

CAM services are non-conventional medical treatments like acupuncture, biofeedback, chiropractic manipulation, hypnosis, massage therapy and diet supplements. Most CAM services are not covered by health insurance.

Most of the $30.2 billion was spent on visits to non-conventional practitioners ($14.7 billion) and natural product supplements ($12.8 billion), according to the NCHS report.

Consumer spending on CAM services “constitute a substantial part of out-of-pocket health care costs and are comparable to out-of-pocket costs for conventional physician services and prescription drugs,” the NCHS said.

New figures released by the Centers for Medicare & Medicaid Services projected out-of-pocket national health expenditures to reach $350.1 billion this year and climb nearly 60 percent to $555.8 billion by 2025.

A separate report from Visa and Oxford Economics said as much as 4 percent of the world’s population travels internationally for medical treatment, spending an estimated $439 billion annually on care outside of their home country. The report said one of the major drivers of growth in the medical tourism business is the fact that certain treatments and medications are not approved or available in a patient’s home country.

The Centers for Disease Control and Prevention estimates that 750,000 U.S. citizens travel to another country for care each year.

The top five countries that medical tourists visit for treatments are Canada, the United Kingdom, Israel, Singapore and India, according to the Medical Tourism Index compiled by the Medical Tourism Association.

David Burda

tcbmag

Will Brexit lead to fewer NHS physicians and more medical tourism?

In late June, the U.K. decided to leave the European Union (EU) based on the belief that it would gain more autonomy and strengthen its economy. But how will the newly independent nation ensure that its foreign-born physicians — who make up a quarter of the total — don't depart to their homes in the EU?

One of the main reasons for the U.K.'s "Brexit" was a perceived excess of immigrants, according to Forbes. Consequently, it's possible that the National Health Service (NHS) will face a difficult time recruiting physicians from EU countries — and retaining the ones who wanted to work in a U.K. that belonged to the Union.

NHS leadership has been outspoken in their gratitude for immigrant staff from EU countries. The British Medical Journal reports Jeremy Hunt, England's health secretary, described staff from other EU countries as “a crucial part of our NHS,” while other members of the service paid tribute in a #LoveOurEUStaff social media campaign.

Statistics from the Health and Social Care Information Centre show that 26 percent of all NHS physicians aren't from the U.K. But, according to some experts, that doesn't mean Brexit spells disaster for U.K. hospitals.

Dr. Sophie Chung is no stranger to the concept of going abroad for health care. As the CEO and founder of Junomedical — a medical tourism company that works with carefully chosen hospitals experienced with international patients — she doesn't think Brexit will have an immediate and significant impact on access to care in the U.K.

But other factors might.

"If the strong voices calling for stricter immigration laws and less immigrants in the country who were pro-Brexit get their way, influx of a highly qualified work force supporting the U.K. health care system might suffer," she told HCB News, adding that U.K. citizens have already taken up the trend of traveling for the best care possible.

For those patients, Junomedical provides personalized treatment plans and an overview of how much they should expect everything to cost.

A 2015 market analysis from Transparency Market Research said the global medical tourism industry was worth $10.5 billion in 2012, and is expected to reach $32.5 billion by 2019. That report cites "cultural similarities and geographic proximity" as key factors that contribute to a medical destination.

"If access to health care becomes even more constrained and burdensome, I expect to see even more patients seeking affordable, high-quality health care abroad," said Chung.

There are no easy answers. If Brexit does exacerbate care constraints in the U.K., patients will have to weigh their options against the pound's unfavorable exchange rate and new visa requirements.

Lauren Dubinsky

dotmed

A holistic approach will spur tourism promotion

RE: “Promoting local tourism is a collective effort” (The New Times, July 25).

I fully agree with Francois-Xavier Nziyonsenga that promoting local tourism is a collective effort and more priority should be given to this segment.

However, looking at tourism in totality and the tremendous latent potential that exists in this important sector, international and domestic tourism must actually complement each other and both must be integral parts of the tourism master plan , rather than have one segment as plan A and the other segment as plan B.

While domestic tourism will bring in the numbers, with an untapped target audience of over 11 million, international tourism will bring in the much needed foreign exchange and high spending dollar customers.

Of course, this is not to imply that domestic tourists are not high spenders.Very many are. Similarly, it also does not imply that all international tourists will stay in five star hotels.

What is important is to strike the happy median between international and domestic tourism. And also, simultaneously have a healthy mix of budget and high spending tourists, be they domestic or international ones.

This will ensure that all segments of tourism service providers from budget hotels and even homestays right up to the four and five star hotels will all be smiling in this beautiful land of a Thousand Hills and will make this great nation truly a Remarkable Rwanda!

Clarence Fernandes

newtimes

The Rise of Medical Tourism

Emerging markets are new frontiers for patients

The changing dynamics in medical tourism is shifting focus from traditional destinations to new age leaders that are excelling at their specialties.

For years, Switzerland has been the hub of medical tourism. Patients, particularly the affluent class traveled thousands of miles for treatment, preferring this exotic locale for its superior technology and achievements in medical science.

However, medical tourism has evolved rather differently since the turn of the century. What has changed is the profiling of countries and the emergence of new age destinations specializing in different fields.

Korea, for instance, is emerging as a destination for plastic surgery; Europe for hip and knee replacement surgeries; Philippines and Thailand for cosmetic surgeries and India for heart surgeries.

Globalization of information and word of mouth referrals, especially in the virtual world, are the new drivers of this industry and are changing the dynamics in the favor of emerging markets.

Over 6 million people travel abroad for medical treatment every year. If we consider people who travel domestically too for treatment, the number of medical tourists may touch 10 million.

Why the Shift?

The number of people willing to hop on a plane and fly to a different time zone for treatment is increasing incrementally year-on-year.

This is especially true for patients in the U.S. and the U.K. where either the treatment cost is exorbitant or the wait time is too long for procedures.

With the ease of air travel, patients from these countries have benefitted from improving technology and standards of care in many countries, chiefly some European nations and Asian countries.

Many surgery procedures performed in medical tourism destinations cost a fraction of the price they do in developed nations. To get a perspective let’s compare the cost of a heart surgery in India with the same surgery in the U.S.

A bypass surgery in the U.S. costs around 200,000 AED ($54,644), but in India surgeons conduct the surgery for only 20,000 AED — one-tenth of the cost.

Besides the cost, time is also one of the defining aspects of the shift in medical tourism. A large number of patients willingly travel for convenience and speed. Countries that operate public health-care systems, such as Canada, U.S. and the U.K. often have a long waiting period for certain operations. In 2014, the average patient in Canada was expected to wait almost 10 weeks for necessary medical treatment. As per industry experts, that’s more than three weeks longer than what physicians consider it to be clinically reasonable.

A recent report by Fraser Institute of Canada titled ‘Leaving Canada for Medical Care,’ estimates over 53,000 Canadians left the country in 2014 to receive non-emergency medical treatment, an increase of more than 25 percent from a year earlier.

Additionally, lack of insurance cover or its limitations are also driving demand for medical tourism. Patients in some western countries are constantly finding that insurance either does not cover orthopedic surgery (such as knee or hip replacement), or limits the choice of the facility, surgeon, or prosthetics to be used.

Circumvention Tourism

Circumvention tourism refers to travel to access medical services that are legal in the destination country but forbidden in the home country. This list is long and varies as per country of origin, but largely people travel for fertility treatments, abortion and doctor-assisted suicide, also known as euthanasia.

Abortion tourism can be found most commonly in Europe, where travel between countries is relatively simple. Ireland and Poland, two European countries with highly restrictive abortion laws, have the highest rates of circumvention tourism. In Poland especially, industry experts say that an estimated 7,000 women travel to the U.K. every year, where abortion services are free through the National Health Service (NHS). There are also efforts being made by independent organizations and doctors, such as with Women on Waves, to help women circumvent draconian laws in order to access medical services. With Women on Waves, the organization uses a mobile clinic aboard a ship to provide medical abortions in international waters, where the law of the country whose flag is flown applies.

What Are the Popular Destinations?

Popular medical travel worldwide destinations vary from Latin American countries such as Brazil all the way to Middle Eastern states such as Jordan and Turkey and Asian countries such as India, Thailand and Taiwan.

Patients looking for cosmetic surgery have dozens of countries to pick from including Argentina, Brazil, Korea, and Turkey for their cost-effective and efficient elective treatments.

Jordan was awarded the Medical Destination of the year by IMTJ Medical Travel awards in 2014 for attracting 250,000 international patients and generating revenue of more than $1 billion.

India, on the other hand, is registering a growth of over 30 percent in its year-on-year number of medical tourists, making it a $2 billion industry by the end of 2015. Last year, more than 150,000 people travelled to India as medical tourists.

As per industry experts, India attracts medical tourists chiefly from its neighboring countries, the Middle East, Africa as well as a few European and U.S. patients.

India is also a popular destination for cardiology, joint replacement, spine surgeries, cosmetology and plastic surgeries, and a small number of organ transplants.

Intermediaries

The rising demand and trend for health tourism has opened doors to another service industry called intermediaries, which unite potential medical tourists with provider hospitals and other organizations.

Companies which focus on medical value travel typically provide nurse case managers to assist patients with pre and post-travel medical issues. They may also help provide resources for follow-up care upon the patient’s return.

In Europe, for instance, the European Medical Travel Alliance, routes a lot of traffic of medical tourists into the continent. The idea is to make it easier for patients from overseas (chiefly North America, Russia, or the Middle East) to see Europe as a solution because of its high quality and reasonable prices.

Interestingly, people from the East Coast of the U.S. prefer heading to Europe, while many from the West Coast opt for Asian countries like South Korea, Thailand or India.

UAE as a Medical Hub

The UAE is working aggressively to build expertise in the medical field to become one of the hotspots for medical tourism in the region.

In April 2014, His Highness Sheikh Hamdan bin Mohammed bin Rashid Al Maktoum, Crown Prince of Dubai, approved the Dubai Medical tourism strategy.

The Dubai Health Authority is responsible for the initiative and is entrusted with the responsibility to promote the UAE in this field.

The Emirates is currently looking at building expertise in the following areas: Orthopedics and Sports Medicine, Plastic Surgery, Ophthalmology, Dental Procedures, Dermatology and Skin Care, Aesthetic Practices and surgeries, Preventive health check-ups and wellness.

Dr. Raza Siddiqui

Dr. Raza Siddiqui is the Executive Director of RAK Hospital and CEO of the Arabian Healthcare Group.

newsweekme

80,000 Omanis visited Thailand last year, majority of them were as medical tourists

More than 80,000 Omanis travelled to Thailand in 2015, the designate Thailand Ambassador to the Sultanate of Oman, said.

“A majority of the tourists from Oman visted Thailand for medical treatment,” Ambassador Jesda Katavetin said.

Explaining why his country is a major hub for medical tourism, Katavetin said affordable hospital care, state-of-the-art equipment, well-trained medical personnel, and easy access to doctors makes Thailand a major destination for people who seek quality healthcare.

“Omanis are welcome to get a visa-on-arrival as usual, and Thailand has already offered a multiple-entry visa with a validity of six months and with the entitlement of a period of stay for 60 days at a time,” Katavetin added.

Both the countries are trying to boost the number of tourists coming to both countries, Katavetin explained.

“The launch of new airlines offering direct flights between Bangkok and Muscat might also boost the number of tourists in this sector,” Katavetin stated.

Oman and Thailand have enjoyed an excellent bilateral relationship for a long time and they share a lot of things, Ambassador Katavetin noted.

“We look at the Gulf countries as a new frontier for cooperation,” Katavetin said.

In 2015, the Sultanate and the Kingdom of Thailand celebrated the 35th anniversary of the establishment of diplomatic relations.

“The Kingdom of Thailand can be a good partner for the Sultanate of Oman in its attempt to help diversify the Sultanate’s economy during this crisis period and this is the perfect time to diversify the economy,” Katavetin asserted.

Thailand can also share its expertise and work in sectors, such as tourism, fisheries, and medical services, he added.

“In fields, such as fisheries, Thailand has high expertise and we can easily share with our friends in the Sultanate and help the country diversify its economy,” he said.

“We can help the Sultanate become a fisheries hub in the GCC,” he added.

The Kingdom of Thailand believes it can do more business with the Sultanate of Oman, according to Katavetin.

“An Omani can easily partner in Thailand by investing in the services sector business like the hospital sector,” Katavetin said.

According to him, the people of Oman and Thailand share a solid foundation in furthering bilateral relations and can act as the biggest asset for the two countries.

“The people of Oman and Thailand share a lot of similarities and they are the real asset of these countries,” he said.

“Both the people are known for their great hospitable nature and this makes them different from others,” he added.

Speaking about the Thai community in Oman, the ambassador said, “We have a small community here in Oman, which is around 500 and out of that 300 are working with the national carrier of Oman.”

“This shows the demand for Thai hospitality,” he added.

Katavetin also congratulated His Majesty Sultan Qaboos bin Said, on behalf of the Thai community, on the occasion of the Renaissance Day of the Sultanate.

“We are grateful for His Majesty’s kindness, which allows us to live prosperous lives in this beautiful country. We wish His Majesty good health and happiness,” Katavetin said. Explaining why his country is a major hub for medical tourism, Katavetin said affordable hospital care, state-of-the-art equipment, well-trained medical personnel, and easy access to doctors makes Thailand a major destination for people who seek quality healthcare.

“Omanis are welcome to get a visa-on-arrival as usual, and Thailand has already offered a multiple-entry visa with a validity of six months and with the entitlement of a period of stay for 60 days at a time,” Katavetin added.

Both the countries are trying to boost the number of tourists coming to both countries, Katavetin explained.

“The launch of new airlines offering direct flights between Bangkok and Muscat might also boost the number of tourists in this sector,” Katavetin stated.

Oman and Thailand have enjoyed an excellent bilateral relationship for a long time and they share a lot of things, Ambassador Katavetin noted.

“We look at the Gulf countries as a new frontier for cooperation,” Katavetin said.

In 2015, the Sultanate and the Kingdom of Thailand celebrated the 35th anniversary of the establishment of diplomatic relations.

“The Kingdom of Thailand can be a good partner for the Sultanate of Oman in its attempt to help diversify the Sultanate’s economy during this crisis period and this is the perfect time to diversify the economy,” Katavetin asserted.

Thailand can also share its expertise and work in sectors, such as tourism, fisheries, and medical services, he added.

“In fields, such as fisheries, Thailand has high expertise and we can easily share with our friends in the Sultanate and help the country diversify its economy,” he said.

“We can help the Sultanate become a fisheries hub in the GCC,” he added.

The Kingdom of Thailand believes it can do more business with the Sultanate of Oman, according to Katavetin.

“An Omani can easily partner in Thailand by investing in the services sector business like the hospital sector,” Katavetin said.

According to him, the people of Oman and Thailand share a solid foundation in furthering bilateral relations and can act as the biggest asset for the two countries.

“The people of Oman and Thailand share a lot of similarities and they are the real asset of these countries,” he said.

“Both the people are known for their great hospitable nature and this makes them different from others,” he added.

Speaking about the Thai community in Oman, the ambassador said, “We have a small community here in Oman, which is around 500 and out of that 300 are working with the national carrier of Oman.”

“This shows the demand for Thai hospitality,” he added.

Katavetin also congratulated His Majesty Sultan Qaboos bin Said, on behalf of the Thai community, on the occasion of the Renaissance Day of the Sultanate.

“We are grateful for His Majesty’s kindness, which allows us to live prosperous lives in this beautiful country. We wish His Majesty good health and happiness,” Katavetin said.

Mobin Mathew Blesson

timesofoman

Medical Tourism Industry Valued at $439B; Poised for 25% Year-Over-Year Growth by 2025

In a just released report issued by VISA and Oxford Economics, the Medical Tourism industry was valued at a staggering USD 439 billion, with a projected growth rate of up to 25% year-over-year for the next 10 years as an estimated three to four percent of the world’s population will travel internationally for healthcare and health-related treatment.

For years the medical travel industry seemed undervalued, yet VISA’s report accounts for growth factors – like some 340 new international airports over the next decade – and the medical travel market could soar to an astronomical USD 3 trillion by 2025.

In its just-released 2016 report, industry-leading journal, Medical Tourism Index™ (MTI), listed the top 41 destinations for those seeking value-added services and high quality of healthcare across the globe. In it, the similar pattern of global growth emerges: that the United States leads in terms of market share of healthcare travel spending, but Asia’s Thailand, Singapore and South Korea continue to thrive. Both VISA’s and MTI’s™ findings expect China to overtake the US spot within the next 10 years due to the population’s demand for higher quality of care.

The findings don’t just span the global spectrum but also the age spectrum as well; VISA expects 13 percent of all international travel by 2025 to be older travelers. Meanwhile, a recent survey of 31,000 18-34 year olds from 134 countries by popular booking site TopDeck Travel found that some 88% of them travel internationally between 1 to 3 times annually and that the number only continues to grow.

“The borders to quality healthcare access have begun to dissintegrate.” MTI™ Co-Authors, Renée-Marie Stephano, JD President of the Medical Tourism Association and Marc Fetscherin, Associate Professor of International Business and Marketing at Rollins College, said a joint statement. “Speculation about the medical tourism industry as a ‘phenomenon’ is over. This report and the rankings of the the Medical Tourism Index™ provide a unique opportunity for investors seeking new ventures to make smart choices in destinations driving patient travel.”

The entire medical tourism and health tourism industry will descend upon Washington, D.C., September 25-28, 2016 for the 9thWorld Medical Tourism & Global Healthcare Congress. Over 3,000 attendees from 50+ countries brought USD 1 billion in new deals last year paving the way for leaders this year to catch the next wave in partnerships and medical tourism investment.

In a conclusion, VISA said, “We believe that medical tourism is primed for accelerated growth as more of these travelers seek new treatments, as well as lower cost or higher-quality care not available in their home country.”

Medical Tourism Magazine

Price of Cancer Drugs Has Skyrocketed Since 2000

Researchers say initial prices of new cancer drugs are six times higher, raising the question of if patients are getting their money’s worth.

For some cancer patients, taking a new cancer drug is simply a matter of buying time.

It turns out, though, they are paying a lot for those extra months and years.

A study published today in JAMA Oncology reports that new cancer drugs taken in pill form have become dramatically more expensive in their initial year on the market than other drugs launched 15 years ago.

In addition, the researchers say, the prices of those drugs increase rapidly even after their first year on the market.

Dr. Alan Venook, an oncologist at the University of California, San Francisco, notes that many of these drugs are not even cures. They simply delay the progression of cancer.

“It’s beyond me. I guess they do it [raise prices] because they can do it,” Venook told Healthline. “It’s a big, big problem.”

The Price of Treatment

Researchers looked at 32 orally administered drugs introduced since 2000.

They said the average monthly cost of the drugs approved in that year was $1,869.

That figure rose to $11,325 a month for new drugs introduced in 2014. That’s a sixfold increase, even after adjusting for inflation.

One of the drugs highlighted in the research was imatinib, also known by the brand name Gleevec. When it was launched in 2001, the average monthly cost was $3,346. In 2014, that monthly cost had risen to $8,479. That’s an average annual increase of 7.5 percent.

The researchers said the amount paid by health insurance companies was factored into the cost. They also pointed out that many patients are now paying a higher percentage of these expenses than they were 15 years ago.

"Patients are increasingly taking on the burden of paying for these high-cost specialty drugs as plans move toward use of higher deductibles and co-insurance — where a patient will pay a percentage of the drug cost rather than a flat copay," said study author Stacie Dusetzina, Ph.D., an assistant professor at the University of North Carolina, in a press release.

Officials at the Pharmaceutical Research and Manufacturers of America (PhRMA) said the dramatic improvements in cancer treatment over the past decade have helped people live longer, healthier lives.

They noted the cancer death rate in the United States has fallen 23 percent since its peak and two of three patients diagnosed with cancer now live at least five years after diagnosis.

They added there has been a rapid rise in healthcare plans with high deductibles for medicine.

"Focusing solely on the list prices of medicines is misleading,” Holly Campbell, senior director of communications for PhRMA, told Healthline in an email. " A new report from the IMS Institute found net prices for brand medicines increased just 2.8 percent in 2015, down from 5.1 percent the prior year as discounts and rebates negotiated by payers rose sharply. Similarly, CVS Health and Express Scripts recently reported actual medicine spending growth in 2015 was less than half from the prior year. This is due to a competitive marketplace for medicines where large, powerful purchasers negotiate aggressively."

Is It Worth It?

The price increases bring up two questions.

Who can afford the drugs, and are they getting their money’s worth?

Venook said cancer patients are sometimes put into the position of deciding if they want to drain their finances to slow the progression of their disease.

He has one patient who has been taking Gleevec for years. It’s been effective, but the woman recently decided to take the pill only four times a week to save money.

Venook said the prices also put doctors in a predicament. They want the best for their patients, but that might not always involve taking the latest cancer drug, especially if it’s uncertain how well it will work on a particular patient.

Venook said Gleevec can have good results, so it may be worth the cost.

“It’s a very effective drug,” said Venook. “With that one, they should be able to charge a premium.”

Some of the newer drugs for hepatitis C have also been effective. In some cases, they have cured the disease and allowed patients to forgo expensive treatments such as liver transplants.

“That makes a world of difference to patients,” Venook noted.

Price Based on Value?

Venook said perhaps the best way to regulate the situation is to approve policies that require companies to set prices based on how much benefit certain drugs provide.

He suggested that perhaps a new drug could be given to a patient for free for two months. If it’s effective, then a company could start charging for it.

“The only fair way is to price drugs according to their value,” said Venook.

Dr. Len Lichtenfeld, deputy chief medical officer for the American Cancer Society, said that’s what’s happening in some countries in Europe and other places.

He told Healthline that some European nations will pay a company more for a drug if it’s effective.

He added Medicare officials in the United States are considering a plan to set payments for drugs based on how effective they are against certain diseases.

If a drug works well in treating lung cancer, for example, the pharmaceutical company would be paid more when it’s used on lung cancer patients than when it’s used less effectively on, say, colon cancer patients.

“The solutions are not going to be simple,” said Lichtenfeld. “There has to be a balance.”

Cancer Drugs Aren’t the Only Ones

Cancer drugs aren’t the only pharmaceuticals with a spotlight on them.

On Wednesday, Michael Pearson, the outgoing chief executive officer of Valeant Pharmaceuticals International, told a Senate committee that his firm was too aggressive in raising prices on its drugs.

Valeant acquired the rights to the cardiac-care drugs Isuprel and Nitropress last year. They quickly raised the medications’ prices by 525 percent and 212 percent, respectively, according to the Wall Street Journal.

In addition, the prices of 16 Valeant drugs have increased this year.

The company is under investigation by the Security and Exchange Commission (SEC) and other agencies, the Wall Street Journal reported.

Pearson told the Senate Special Committee on Aging that Valeant has spent $1 billion to help patients afford the cardiac drugs.

However, he acknowledged Valeant’s strategy of acquiring drugs that needed hefty price increases was a mistake.

His testimony came less than three months after Martin Shkreli, the former chief executive of Turing Pharmaceuticals, refused to answer questions at a House committee hearing on the rising price of drugs.

Turing made the news last year when the company bought the rights to the drug Daraprim and then raised the price per pill from $13 to $750.

Another pharmaceutical company, Gilead, made news in 2014 when it started selling the drug Sovaldi for $84,000 for a 12-week treatment regimen.

The drug has a 95 percent cure for hepatitis C.

These and other price hikes have led many consumer advocates to question why some prescription drugs cost so much and others don’t.

This spring the Federal Drug Administration (FDA) quietly started a program to speed up the drug approval process to help avoid future price gouging.

The goal is to bring more drugs onto the market, thus increasing competition and forcing down the prices of prescriptions.

David Mills

healthline

You can find older posts regarding ASEAN politics and economics news at SBC blog, and older posts regarding health and healthcare at IIMS blog. I thank you.

Cancer surgeons advise against removal of healthy breast

Only certain women with cancer in one breast should have their healthy breast removed in an attempt to prevent cancer, a leading group of breast surgeons maintains.

The new position statement from the American Society of Breast Surgeons comes at a time when more breast cancer patients are asking doctors to remove the unaffected breast—a procedure known as contralateral prophylactic mastectomy.

"Contralateral prophylactic mastectomy is a growing trend that has generated significant discussion among physicians, patients, breast cancer advocates and media," said position statement lead author Dr. Judy Boughey. She is professor of surgery at Mayo Clinic in Rochester, Minn.

However, "it is important for patients to understand it does not improve their cancer outcome and for them to understand the pros, cons and alternatives to [contralateral prophylactic mastectomy]," she said in a society news release.

The surgeons' group believes the procedure should generally be discouraged in average-risk women, whose chances of developing breast cancer in the healthy breast are only 0.1 to 0.6 percent a year.

And research shows that most women with cancer in one breast gain no cancer-prevention benefit from removal of the healthy breast, the society said.

One group at high risk, for whom the surgery might be warranted, includes women with BRCA 1 or BRCA 2 gene mutations. This was the type carried by actress Angelina Jolie, who did not have breast cancer but who underwent prophylactic double mastectomy in 2013 to lessen her chances for the disease.

According to the guidelines, other women who may opt for contralateral prophylactic mastectomy are those with a lifetime breast cancer risk greater than 25 percent who have not had genetic testing, or those who received "mantle" radiation before age 30. The mantle field includes the lymph node areas in the neck, chest, and under the arms.

The surgery may also be appropriate for women with other genetic risks; a strong family history of breast cancer; dense breasts; extreme disease-related anxiety; or concerns about breast reconstruction symmetry.

"Typically, the decision to perform a contralateral procedure is based on a combination of the patient's perceived risk and fear of future breast cancer, anxiety about annual screening and possible additional diagnostic procedures, as well as the uncertainty of physical, emotional and cosmetic surgical outcomes," said statement senior author Dr. Julie Margenthaler. She is a professor in the division of general surgery at Washington University School of Medicine in St. Louis.

Surgeons should make a clear recommendation for or against the surgery from a medical standpoint to each patient, the authors said.

However, patients' values and preferences should also be an important part of a shared decision-making process, according to the statement.

"The society believes that a final treatment plan should be based largely on an analysis of the risks and benefits of contralateral mastectomy, and the patient's perspective on surgery," Margenthaler said.

She added: "Patient education on those risks and benefits, all treatment options and recurrence risks are crucial. A well-planned patient-surgeon discussion to facilitate this is extremely important."

Dr. Stephanie Bernik, chief of surgical oncology at Lenox Hill Hospital in New York City, reviewed the new guidelines. She agreed with the advisory, but said the ultimate decision must always be in the patient's hands.

"If a woman is properly counseled and concludes that she wants to move forward with the surgery, a bilateral mastectomy is still an option," Bernik said.

Sometimes breast aesthetics are part of the decision process, she noted.

"One of the most common reasons for a bilateral mastectomy is for symmetry, and this is still a legitimate reason to go forward with removal of both breasts," Bernik said.

"A few of the other reasons include strong family history, aversion to ongoing testing, and extreme emotional anxiety due to testing," she said.

The statement was published July 28 in the journal Annals of Surgical Oncology.

medicalxpress

You can find older posts regarding ASEAN politics and economics news at SBC blog, and older posts regarding health and healthcare at IIMS blog. I thank you.