Abstract
This study examined the effects of the separation between dispensing and prescribing medicines by pharmacists in pharmacies and doctors in medical institutions, respectively (separation system). The methodology avails public national data. The participation of Japanese medical institutions to the separation system was optional according to the legal system. Consequently, its spreading rate for each administrative district is highly variable, allowing us to study its correlation with various medication costs and other factors, such as the generic medicine replacement ratio, proportion of elderly, and number of doctors per 100 000 individuals as independent variables. These four factors are known to be influential in medical compensation. We used regression analysis by the weighted least square method, with dependent variables being costs of daily medicines, specifically, total, internal, one-shot, external, and injection medicines; medical devices, brand-name medicines, generic medicines, and number of prescribed medicines; as well as technical fees. The analysis focused on whether the extent of the separation system reduces costs such as those for medicines, medical devices, technical fees, or number of prescribed medicines. The partial regression coefficient of the spreading rate of the separation system was found to have negative relationships with all daily costs and number of prescribed medicines, as well as the technical fee, except for external medicines, for which most of the market is represented by light analgesics (taken by patients as needed). The necessity of separating prescribing and dispensing is thus low because of the low information asymmetry between doctors and patients. The results revealed that promoting the separation system reduced medication costs, because it normalized the medication market for daily necessities by compensating information asymmetry. Furthermore, the separation system reduced excesses in prescribing medicines.
Highlights
In the late 20th century, Japan introduced separation between prescription and dispensation medicines by doctors in medical institutions and pharmacists in pharmacies, respectively
The partial regression coefficient of the spreading rate of the separation system was found to have negative relationships with all daily costs and number of prescribed medicines, as well as the technical fee, except for external medicines, for which most of the market is represented by light analgesics
The analysis focused on whether the spreading of the separation system was the determinant for reducing costs such as for medicines, medical devices, technical fee, number of prescribed medicines
Summary
In the late 20th century, Japan introduced separation between prescription and dispensation medicines by doctors in medical institutions and pharmacists in pharmacies, respectively (hereafter, separation system). When the economic evaluations of clinical pharmacy interventions were studied, methodological problems appeared, including the absence of a control group, as the listing of public medicine prices undergoes a revision once every two years in addition to four revisions a year, the changes being too frequent to compare each fiscal year data. It is impossible to undertake a double-blind test of the separation system, as experience content, by its nature, must be known by doctors, patients, and pharmacists. Despite these difficulties, Japan’s separation system proliferated in the 1990s and, in 2016, was present in over 70% of all healthcare facilities in Japan according to the Japan Pharmaceutical Association (2016)
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