Pharmaceutical sales by volume in Turkey has increased some 170% over 2002–12. This growth is being driven by physician willingness to prescribe medicines, irrational prescribing of medicines, and patient stockpiling.
IHS Global Insight perspective | |
Significance | Prescribed pharmaceutical volume has reportedly risen from 700 million packages in 2002 to 1.9 billion in 2012. Prescribing within primary care settings is typically high, with 95% of Turkish patients being written a prescription on first visiting a physician. |
Implications | Much of the increase in pharmaceutical consumption has been driven by physicians' willingness to prescribe medicines, and medicines that patients ask for. In addition, stockpiling is becoming increasingly common with patients frequently passing prescription medicine onto family members without physician consultation. |
Outlook | There is the real risk of antibiotic resistance through the over-prescribing of antibiotics. Rational prescribing of medicines and stockpiling can likely only be addressed through addressing concerns over the possibility of drug shortages and violence against healthcare staff. |
The number of pharmaceutical packages sold within the Turkish market has grown at some 170% between 2002 and 2012, according to reports in the Turkish Newspaper Today's Zaman. According to statistics quoted in the newspaper, some 1.9 billion packages of drugs were sold in 2012, up from 700 million in 2002. Drugs are most commonly prescribed in primary care settings, where 45.6% of medicines were prescribed. Some 35.9% were prescribed by public hospital physicians, 15.4% by private hospital physicians, and 3% by university hospital based physicians. The most prescribed medicine in Turkey is believed to be antibiotics representing 11.3% of prescriptions, followed by anti-diabetic medicines (5.9%), asthma medicines (5.9%), and ulcer medication (5.2%).
Driving part of the uptake of medicines has been willingness for physicians to prescribe medicines, some 95% of Turkish patients being prescribed a medicine upon first examination with a primary healthcare physician, compared to 15–25% in the EU. The vice-president of the Turkish Drug and Medical Device Institution, Hakki Gürsöz, suggests that this high prescribing rate is being driven by a shortage of doctors leading to shorter consultation times, driving many doctors to conduct short consultations that may lead to rapid prescribing.
Despite increasing prosperity and demand for healthcare services driving increased demand for pharmaceuticals, stockpiling of drugs is reportedly becoming more common. According to a survey conducted by the Turkish Social Security Institution (SGK), and referenced in the newspaper, there were believed to be some 190 million drug packages stockpiled in Turkish homes, amounting to an average of 11 packages per household. Within these packages, it is believed on average one-third of the product remains. According to the reports most households stockpile drugs which they believe may be essential in the future such as painkillers, antibiotics, or cold and flu medicine. Compounding these rates of stockpiling are reports that patients are increasingly able to obtain medicines on demand, with the aim of stockpiling. Patients frequently request medicines that have no relation to their current medication, and may seek consultation with another physician should they not receive their requested medication.
Outlook and implications
With prescription rates for antibiotics being very high in Turkey, there are serious risks associated with the development of antibiotic resistance –leading to prescribing restrictions or physician reluctance to prescribe these drugs in many mature markets. In addition, some medicines commonly stockpiled, such as painkillers, can have serious adverse events, especially in patients with underlying health conditions. The use of these medicines by patients not prescribed them can therefore have serious consequences.
Driving many physicians to prescribe medicines that patients do not require may be increasing rates of violence against healthcare staff - the threat of violence likely encouraging many physicians to prescribe medicines against their will. In order to combat high rates of violence in these settings, the Turkish government is increasingly introducing security personnel in hospitals and providing self defence training to staff (see Turkey: 28 December 2012: Turkey reaffirms public-private partnerships hospital initiative). Although this is being introduced it may take a while for attitudes towards physicians to change.
The demand for unnecessary medicines is likely to place a strain on relatively short resources in the Turkish healthcare system as patients who do not require medication sap reimbursement funding. With drug reimbursement levels likely to remain flat this year (see Turkey: 29 November 2012: Turkish drug reimbursement funding could remain flat), there is the possibility that increased uptake of medicines could lead to addition price cuts – historic price cuts already having a severe impact on Turkish pharmaceutical companies. Alternatively, patients who require more expensive medication may lose out. Tackling the issue of overprescribing could therefore reduce the burden of Turkey's burgeoning demand for pharmaceuticals, or lead to increased uptake of more expensive complex medicines.
An industry group, the Turkish Association of Research-Based Pharmaceutical Companies (AiFD) has previously suggested that Turkey could begin to see drug shortages if there is no reform of the pricing system (see Turkey: 11 March 2013: Turkish pharma industry association criticises current drug pricing policy). Public concern over these shortages is likely to compound the stockpiling situation.