ABSTRACT
In addition to the notion of promoting generic drugs to lower pharmaceutical costs, another approach that has gained attention as vital to policy reform is that of utilizing health insurance pharmacies to decrease over-prescription and surplus of drugs. Such a move would perforce require separating medical and dispensary practices. There is increased need for more efficient provision of pharmaceuticals, including proper inventory control, outpatient clinics that function as family pharmacies, and support of home-bound patients’ medication regimens. However, chronic ailments in particular tend to lack subjective symptoms, and decreased intake of medication and surplus medication compound to make these larger policy issues difficult to solve. This has led to the Revised Dispensing Service Fee changes in 2012 and 2014 putting stricter controls on medication regimens and checks of surplus medication. This research examines in parallel the issues of patient satisfaction and loyalty alongside adherence to medication regimens, issues that have been previously treated in isolation in the existing literature. By comparing their respective inter-relationships and influencing factors, we conducted a re-analysis of the relationship between insurance pharmacies and patients. We collected data from patients with diabetes and high blood pressure via an Internet survey. Responses on loyalty, patient satisfaction, overall perceived quality, and degree of medication adherence were obtained, as well as responses on the factors believed in a cross-sectional sense across research disciplines to contribute to the above, and the results measured on a quantitative scale. Path analysis was then used, with a model defined using overall perceived quality as a parameter and measuring the degree of satisfaction, loyalty, and medication adherence. In addition, a multiple-group analysis was simultaneously performed. Although there was variance by ailment in terms of patient satisfaction and loyalty, factors contributing to perceived quality were the strongest, followed by the rating of the prescribing doctor. However, for adherence, only self-efficacy and prescribing doctor rating contributed. Ultimately, no correlation was found between patient satisfaction, loyalty, and adherence, and the contributing causes were found to vary, so improving these various vectors would seem to require respectively differing strategies. In terms of medication adherence, the results suggested the need for strategies to increase patients’ self-efficacy, partner with prescribing doctors, and improve the perceived rating of prescribing doctors; different quality improvements are needed by medical area, whether medicine or dispensary practice.
ABSTRACT
The separation of pharmaceutical prescription and dispensing has been mandatory in Korea since July 1, 2000. This policy aimed to reduce drug abuse, prevent the distribution of drugs without a prescription, decrease medical costs and insurance premiums, and provide high-quality health-care services. However, the policy was launched without careful consideration of actual benefits to patients or the resulting national financial burden, and its initial aims remain unfulfilled. Koreans have complained that the policy is inconvenient; a 2008 survey revealed that 87% of people would prefer to have their medications dispensed at medical institutes, rather than at pharmacies. People wish to select a convenient dispensing site; the current policy particularly inconveniences disabled and elderly individuals. From 2000 to 2009, dispensing fees totaled 18,432.4 billion Korean won (16.4 billion US dollar), comprising 27% of all pharmaceutical costs. These fees have contributed to the accelerated rise in national health-care expenses (the most rapid in the world) and to the 2.2-fold increase in insurance-premium payments in 2009, in contrast to those in 2000. Pharmaceuticals continue to be dispensed without a physician's prescription and antibiotic abuse has not been controlled. The increasingly prevalent occurrence of multi-drug resistant bacteria constitutes a serious social problem. The Korean government should recognize the difficulties posed by the financial burden of this policy and its failure to achieve a separation between pharmaceutical prescription and dispensing. To improve this policy, we urge the government to undertake a fair and scientific re-evaluation, despite objections by interest groups to such actions.