Structural Evaluation of the Impact of the separation of dispensing and prescribing functions on Drug Costs A structural equation modeling study

Abstract

As national healthcare costs continue to rise, the concomitant increase in drug fees is also remarkable. This study focuses on drug fees for outpatient prescriptions as part of the ever-increasing medical care costs. We examine the impact of the current separation of dispensing and prescribing functions on daily drug fees, per prescription per type for outpatient prescriptions (hereinafter referred to as drug fees), using national data on a prefectural basis. Instead of conventional regression or correlation analyses, this study employs path analysis, a type of structural equation modeling (SEM), to examine the impact of the current separation of dispensing and prescribing functions on prefectural-level national data. We also include per capita prefectural income and the number of people (per 1,000 population) on public assistance, as socioeconomic factors, and compare the total, indirect, and direct effects of the progress of separation of dispensing and prescribing functions on drug fees. The results show that a 100,000 yen increase in per capita prefectural income per year would increase drug costs by 0.377 yen (total effect), a one percentage point increase in separation of dispensing and prescribing functions would decrease drug costs by 0.228 yen (total effect), and an increase of one person (per 1,000 population) on public assistance would increase drug costs by 0.093 yen (indirect effect), a one percentage point increase in the percentage of the population aged 65 and over would increase the drug costs by 0.135 yen (indirect effect). This indicates that, within this model, separation of dispensing and prescribing functions and its progress may be suppressing rising medical costs due to socio-economic changes, especially the daily drug fee per prescription per type per day. This study uses a hypothetical model to demonstrate the possibility that the development and maintenance of an appropriate separation of dispensing and prescribing functions could curb the rise in drug costs for dispensed medical care.