Cost Structure of Hospital-Based Pharmaceutical Services: a Consideration of ReimbursementA. Riewpaiboon,* N. Jaroenkitpan and Y. Wipaswacharayotin
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In Thailand, fee-for-service is employed for the civil servants medical benefit scheme. While there are variations in the services among hospitals, the mark-up method based on drug prices has been applied ignoring the pharmaceutical services provided. Therefore, this study was aimed to explore cost structure of pharmacy department and propose more appropriate reimbursement method. The study selected a 509-bed general hospital in southern Thailand by convenience. Resources consumed in fiscal year 2001 were collected. Standard costing method was employed. The costs covered capital, labor and material costs, and both direct and indirect costs. Results revealed that cost of all pharmaceutical services was accounted for 19% of the total drug cost. Costs of procurement and dispensing were 4.99% of the total drug cost. Cost of drug dispensing accounted for 9.07% of the total drug cost. Considering drug procurement as supporting activity of drug dispensing, both costs accounted for 14.06% of the total drug cost. Patient-specific pharmaceutical services provided cost 3.96% of the total drug cost. Sensitivity analysis regarding an increase of pharmaceutical personnel demonstrated an increase of the proportion of cost of pharmaceutical services from 19% to 26%. Based on the Ministry of Public Health guidelines on price setting, hospital drug prices are based on a 25% mark-up of purchasing prices. Comparing reimbursable amount to the cost, the analyses showed uncertainty of cost recovery of the pharmacy department, resulting from inappropriateness of the reimbursement method. Reimbursable components and reimbursement methods were reviewed. Variable professional fee was proposed. In conclusion, the proposed pharmacy reimbursement system should separate drug cost and the pharmaceutical services. Methods for basic drug dispensing and patient-specific pharmaceutical services should be bundled and debundled methods, respectively.
Keyword:
fee-for-service, hospital pharmacy, pharmaceutical services, reimbursement, professional fee, civil servants
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