Abstract
BackgroundPredicting pharmacy service fees is crucial to sustain the health insurance budget and maintain pharmacy management. However, there is no evidence on how to predict pharmacy service fees at the population level. This study compares the status of pharmacy services and constructs regression model to project annual pharmacy service fees in Korea.MethodsWe conducted a time-series analysis by using sample data from the national health insurance database from 2006 and 2012. To reflect the latest trend, we categorized pharmacies into general hospital, special hospital, and clinic outpatient pharmacies based on the major source of service fees, using a 1% sample of the 2012 data. We estimated the daily number of prescriptions, pharmacy service fees, and drugs costs according to these three types of pharmacy services. To forecast pharmacy service fees, a regression model was constructed to estimate annual fees in the following year (2013). The dependent variable was pharmacy service fees and the independent variables were the number of prescriptions and service fees per pharmacy, ratio of patients (≥ 65 years), conversion factor, change of policy, and types of pharmacy services.ResultsAmong the 21,283 pharmacies identified, 5.0% (1064), 4.6% (974), and 77.5% (16,340) were general hospital, special hospital, and clinic outpatient pharmacies, respectively, in 2012. General hospital pharmacies showed a higher daily number of prescriptions (111.9), higher pharmacy service fees ($25,546,342), and higher annual drugs costs ($215,728,000) per pharmacy than any other pharmacy (p < 0.05). The regression model to project found the ratio of patients aged 65 years and older and the conversion factor to be associated with an increase in pharmacy service fees. It also estimated the future rate of increase in pharmacy service fees to be between 3.1% and 7.8%.ConclusionsGeneral hospital outpatient pharmacies spent more on annual pharmacy service fees than any other type of pharmacy. The forecast of annual pharmacy service fees in Korea was similar to that of Australia, but not that of the United Kingdom.
Highlights
Predicting pharmacy service fees is crucial to sustain the health insurance budget and maintain pharmacy management
Regression model to project pharmacy service fees per pharmacy per quarter The time-series cross-section data analysis estimated that the quarterly pharmacy service fees per pharmacy increased by $4.7 for one additional prescription per pharmacy
Hospital type General hospital outpatient pharmacy c Special hospital outpatient pharmacy d Clinic outpatient pharmacy e Other f aCosts in Korean won were converted into US$ by using the conversion rate of 1200 won/US$ bStandard deviation cPharmacy that obtained more than 80% of prescriptions from general hospitals dPharmacy that obtained more than 80% of prescriptions from special hospitals ePharmacy that obtained more than 80% of prescriptions from clinics fPharmacy that was not c, d, or e
Summary
Predicting pharmacy service fees is crucial to sustain the health insurance budget and maintain pharmacy management. There is no evidence on how to predict pharmacy service fees at the population level. This study compares the status of pharmacy services and constructs regression model to project annual pharmacy service fees in Korea. Forecasting pharmacy service fees, in particular, can be important to sustain the health insurance budget from the payer’s perspective while maintaining pharmacy management. Several studies have used statistical modelling approaches based on pharmacy insurance claims data to predict annual healthcare costs in the United States and Canada [4, 5]. Despite the plethora of research, no evidence exists on how to predict pharmacy service fees at the population level
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