ESRI Research Paper No.4
Promotion of the Separation of Dispensing from Medical Practice
and Its Impact on Public Finances for Medical Insurance
August, 2003
- Osamu Sasaki
- (Economic and Social Research Institute, Cabinet Office)
- Yasuyuki Gunji
- (Economic and Social Research Institute, Cabinet Office)
The full text is written in Japanese.
(Summary)
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Recently, approximately 40% of gross national medical expenditures growing at annual rate of 2-4% result from the separation of dispensing from medical practice. Basing on this fact, we analyzed the impact on the public finances for medical insurance if such policy of separation is sustained.
Results of the Analysis
- I. The Impact on Public Finances for Medical Insurance
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The separation of dispensing from medical practice was induced by the medical service fee system. The switchover of the receipt of the medical drugs from the medical institutions to the pharmacies leads to the receipt of new payments by both institutions. Estimating these expenses on the assumption of 100% separation shows a net increase in medical expenses worth of 1698.7 billion yen.
The gap in the amount of the medicines per one medical examination in case of formulation in hospital dispensary and the amount of medicines in case of writing a prescription was shrinking till 1998 although the amount of medicines formulated in hospital dispensary was bigger. Nevertheless, in 1999 the situation changed and the amount of prescription medicine became bigger.
- II. The Impact on the Medical Drugs Expenses
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The changeover from the drugs formulated in hospital dispensary to the prescription drugs contributes to the decrease in the medical expenses through the reduction in dosage, but the impact of the increase in medical expenses (net increase amounted to153.7 billion yen) was stronger in 1999.
The average charge for the medical products received in the pharmacies tends to be higher than that for the products formulated in the hospital dispensary. However, since pharmacists do not have a right of decision on the prescribed medicines, they have to prepare on the basis of prescription issued by the medical institutions. The bargaining power of intensive pharmacies concerning the price of medicines is strengthening. Nevertheless, since they do not have a decision right on the medicine dosage, there is no problem of revenue arising from the difference from official price.
Proposal
- III. The Future of Separation of Dispensing from Medical Practice and Dispensing Fee
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The promotion of the separation of dispensing from medical practice is often associated with demerits such as an increase in time and expenses. Besides, there is a problem of uniformity of dispensing fees. Therefore, the rational reform should be conducted to the satisfaction of the patients with the burden of expense under the situation of tight public finances for medical insurance.