
Ülkemizde ilaç bir türlü gün ışığına kavuşamadı; hep gece ile tan aralığında, başka bir deyişle Araf’ta kaldı. Bu kalışın detayını bir yana bırakıp, ilaç fiyat artışının nedenlerine kısaca değinelim.
ÜRETİMDEN TÜKETİME
1) Üretim - İthalat: İlaç, değer olarak ya ithaldir ya da çoklukla yabancı sermaye eline geçen üreticiler tarafından üretilir.
2) Dağıtım: Dağıtımda yani ecza depoculuğu konusunda dünyada en iyiler içinde sayılıyoruz. Bu başarıda çıtayı yükselten Ecza/Eczacı Kooperatiflerinin ön alması tartışılamaz.
2) Sunum: İlacın hastaya ulaşmasında da Türk Eczacıları, sıkıntılarına rağmen hastalarıyla barışık olabilme başarısını sağladı sağlamakta. Bu başarıda hocalarımızın hakkını ödeyemeyiz. Bize “Hastaya tepeden bakmayın” öğretisini iyi ki de dayatmışlar.
ÜRETİMDE SIKINTI:
1) ARGE - Yerli Üretim: Üretimde dışa bağımlılık her alanda olduğu gibi ilaç konusunda da birincil etmen. Küresel salgın sayesinde(!) aşı laboratuvarlarının neden kapatıldığını az çok sorguladık. Her nedense önce duvara toslamamız gerekiyor; şöyle ki: F-16 uçaklarının verilmemesi sonunda kendi savaş uçaklarımızı yapmaya yönelmemize ne kadar benziyor değil mi?
2) Ulusal İlaç Sektörüne Can Suyu: Bizim kuruluşlarımız desteksiz kalırsa emperyal devlerle boy ölçüşemez.
ECZANELER VE İLAÇ ZAMMI KONUSU
Türkiye’mizde, ilaç kadar disiplin altında olan başka bir zorunlu tüketim değeri yoktur. Bu durum olumludur. Ancak ilaç kıtlığı üretimdeki sıkıntıdan kaynaklansa da aşılamayacak bir sorun değildir. En önemli etken İlaç Fiyat Kararnamesinin güncel tutulmasıdır.
Fiyatlandırmadaki gecikmeler ya da yetersizlikler zincirleme olarak, tüm kademeleri sunumda ketum davranmaya iteliyor. Eczaneleri bu kademelerden ayrı tutuyorum. Çünkü elindeki ilacı saklama lüksü yok; çünkü YOK satarsa kaybedeceği hasta/müşterinin geri dönmeme riski yüksek.
Peki eczacı eczanesini ayakta tutabilmek için ne yapıyor? Bulabildiği kadar ilacı bolca almaya yöneliyor; çok aldığı ilaçların bir bölümü son kullanma tarihine takılıyor; gereksiz (tapon) ilaç eczane işletmesini zayıflatıyor. Sonuç; banka kredisine hücum!
Denebilir ki ilaç zam gelince eczacı “köşeyi dönüyor”. Buradaki ironiyi anlamakta zorlanabiliyoruz. Konuyu kısaca rakamlarla açıklamaya çalışalım:
1- Orta düzey bir eczanenin stoğunda tuttuğu ilaç iki aylık cirosu kadardır. Örneğimizde eczanenin cirosu 300 bin TL olsun. Bu 600 bin TL stok seviyesi demektir.
2- Cironun %20’si reçetesiz ilaç satışı ile ilaç dışı ürün satışı olsun. 300 bin TL’lik ciro içinde kamu payı %80 yani 300x80:100=240.000.- TL eder.
3- Kamu alacakları yaklaşık 3 ayda tahsil edilebiliyor. Bu şu demek: İlaca zam geldiğinde örnek eczanemizin 240x3=720.000.- TL kamu alacağı var demektir. Ortalama stok seviyesi 600.000.- TL idi. 720-600=120.000.- TL’ye düşen zam farkı açık ara güme gidiyor. Üstelik kamu alacağından elde edilen gelir payı göreceli olmaktan öteye gitmiyor.
4- Eczacının çıkmazı önlenebilir mi? En aza indirmenin yolları var: Kur ayarlamaları en fazla üç ayda bir yapılmalı; eczacı karı ortalama %30’lara çıkarılmalı; reçete hizmet bedeli kabul edilebilir bir seviyeye yükseltilmelidir.
Unutulmamalı, eczaneler yüz binin üstünde aileye ekmek parası sağlıyor.
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