Impact of separating drug prescribing and dispensing on provider behaviour: Taiwan's experience

Abstract

In many Asian countries, physicians both prescribe and dispense drugs. This practice is hypothesized to have caused high drug expenditure and widespread prescription of antibiotics in Asia. Recently, Taiwan implemented the separation policy on an experimental basis. This paper's objective is to empirically evaluate the impact of Taiwan's reform to separate drug prescribing and dispensing on drug expenditure and total health expenditure. The research design consists of a pre/post comparison of the experimental with the control sites (difference-in-difference). Separation policy was implemented in Kaohsung and Taipei in March 1997, and expanded to Chia-yi and Taichung in March 1998. Changes in drug prescription behaviour before and after implementation in these two pairs of experimental cities were compared to Hsin-chu and Tainan (control), where separation policy was not implemented during the study period. To reduce resistance, providers in experimental sites were allowed to hire on-site pharmacists and dispense drugs through them if they chose to do so. Our study sample consists of all outpatient visits to clinics in the study sites between December 1996 and June 1998, with a total of 55.23 million claim records. The drug prescription rate, drug expenditure and total health expenditure per visit were the main outcome measures. We found that the probability of prescription and drug expenditure per visit were, respectively, 17-34% and 12-36% less among visits to clinics without on-site pharmacists, compared with the control sites. However, no difference in total health expenditure was found between these two types of visits. Hence, the separation policy could be effective in reducing drug expenditure and affecting prescription behaviour, but is less certain as a policy for reducing total health expenditure. We also found that the policy has practically no effect on clinics that have on-site pharmacists.

Public Perceptions towards Implementation of Dispensing Separation: Results from a Cross Sectional Analysis

“…On the other hand, Chou and colleagues investigated the impact of the dispensing ban in Taiwan and reported significant decrease in the drug expenditures per visit [18]. Moreover, dispensing separation in Japan effectively reduced medicine costs and based on the medical economic efficiency, the authors urged that separation should be expanded to countries in which the system is underdeveloped [19].…”

“…We have to realize that most healthcare reforms have unavoidable conflicts with various stakeholders. In fact, the Korean and Taiwanese resistance to dispensing separation are vibrant examples in literature [18,25]. However, the same examples can be taken as a blue print in developing the dispensing separation policy in Malaysia.…”

Health Service Delivery In China: A Literature Review

“…Experience from Taiwan and elsewhere has, however, shown that such reforms have to reconcile many strong interests, making effective reform difficult. 44 …”

Antibiotics Dispensing for URTIs by Community Pharmacists and General Medical Practitioners in Penang, Malaysia: A Comparative Study using Simulated Patients

“…Results showed that policy of reform in Korea benefitted in reducing prescribing of all medicines and antibiotics particularly for viral infections. In Taiwan it could be useful in reducing drug expenditure and prescribing habits of dispensing doctors but has no impact on total health expenditure [3,4]. To prepare a platform for the policy of separation, all health professionals, policy makers and the public should be involved and the current status should also be broadly evaluated [5].…”