Separation of Dispensing in Taiwan

xW~Separation of Dispensing in Taiwan

B  dOIw(KQ|)~T@_ IAOSA@ _QJOIIHA[JO tAKQ~T@_FYNI ~C FBFI~nB AFoFAHAt ~ASsLUAz ~AouhBM~v AAouBwBKvDAF BPidC B L J  ~? ~@jNww i(Hippurates)AOORw ]Cw1264~_w}lI~A wC~vCjOvMd f}BAMABAiH a~C ~OvPvUqM~uX@ AhOuvBBv BvCvME_BBm}BAvh v}fwBtA C vBAvBC~nB? 1.iovPvoM~AAu Xz~AAA~C 2.OuvPuvvQCigB Dv}vO~APv KABAio~R M~AC 3.~yqztA~~AHT O~PwC 4.b(EOP~OOCb)AK] AiOIOOAOI]AQOI HiOOtAdOIoHg C KQ|~@_[JO tAV~{OC ~uA~vPu~ BvvQCOS\? BGTBwI~BB C GA~A~kBqB @BTB@C dGOBd@BNC UGvA~C SOIbOIttOww KBwBgAC vBvUMAUqAOuDC OOS? OSOgFYAH ~Au}~@~Wd~A XOSSnIWwAA~w C u}~@~WdOFTO~@~ ~A~HB]IB]B~ @~BzBOsYWwC vOUfwoOADvCOSSnIeO? FSzdOIAyqwA DnSzyBSBS ]mBS~mA`~~ AYWwC OSifwAi@BTOfw wC ~UAvd?v()nDA~U u@AB~G~HWABD {i~||QpHWA~b| ~G~HW@C]M~A~owC ~biawIh~AvM|N BfHS~Av() M~ACByXiPvb}B pVAPv]@PtdA fwOh@hOC ~ifC @~UAzvQ?  dOIkWwAOSOOI Ac@AivBOS ~ANioM~v()~h BM~AAzBwBKDC ~vBvBO@s AuvPvtXA~ou d@CFAdvqA@PF ~FC BOSAAILOCFQFU~  ddOIAFw UKQ|~T@_}A P~@_QJOIIHA[J OtAV~{OAi {A~@COG~ (KQ~T@)AFnI~J wFC ~@PdAh@hdOC @Gy~nBhzU(OWFBo)

By December 1995, there were 34,724 pharmaceutical firms in the Taiwan Area . For effective control, local health agencies conduct unscheduled census surveys of pharmaceutical firms and also organize meetings with them for better communication and to assist in solving their problems. To improve the professional practice of pharmacists, action has been taken following the Chapter on the control of pharmaceutical firms of the Law of Pharmaceutical Affairs. Continuing education programs have also been organized to upgrade the professional skills of community pharmacists.

To protect the consumer's right of knowing the medicines prescribed and the freedom to choose their dispenser and to safeguard their safe use of medicines, a policy to separate dispensing practice from medical practice as a part of the national health insurance program was decided in 1988. A study of the demand and supply of pharmaceutical manpower in the case of the separation of dispensing practice from medical practice was conducted by the Public Health Association of the Republic of China. In March 1990, at the National Health Conference, a policy to separate dispensing practice from medical practice in the future national health insurance program was decided, and a resolution to establish a planning committee including representatives of consumers, medical associations, pharmacist associations, scholars and experts and insurance agencies to plan for the separation of these practices was adopted. In November 1990, a plan for the supervision of community pharmacies and for the promotion of the separation of dispensing practice from medical practice was drafted. The plan was reviewed by the Planning Committee of the National Health Insurance Program and later approved for implementation by the Executive Yuan on 6 August 1992 uner the name of Pilot Project for the Promotion of the Separation of Dispensing Practice from Medical Practice.

1) Strategies in the Separation of the Two Practices
That the National Health Insurance Program should be built upon the separation of dispensing practice from medical practice is an already decided policy of the Government. However, under the tradition of joint prescribing and dispensing practice long-existing in the medical care system in the Taiwan Area, problems related to the medication behavior of the public, reimbursement by the insurance program, and the management of pharmaceutical dealers and pharmacies cannot be overcome overnight, therefore, the separation of dispensing practice from medical practice will have to be promoted step by step. The impacts that the new practice may have upon the consumers, the medical care system and the financial system of the health insurance program have to be understood. Action should also be taken at the same time to educate the consumers the concept of separating dispensing from medical practices, to urge medical practitioners to change their ways of practice, and to improve the management of pharmacies so as to lay a sound foundation for the separation of dispensing practice from medical practice.

In accordance with the Pilot Project approved by the Executive Yuan and the implementation of the National Health Insurance Program on 1 March 1995, the separation of dispensing practice from medical practice will be promoted through improving the professional functions of community pharmacies, revising relevant laws and regulations, and promoting educational activities to advocate the new concept. Specifically, the strategies are as follows:

       (1) With the implementation of the National Health Insurance Program, community pharmacies will be assisted to   become contracted pharmacies under the National Health Insurance Program and will be a part of the medical care delivery system. To improve the professional functions of the community pharmacies, plans have been made to improve
     the professional quality and facilities of the community pharmacies and to advocate, through the use of various mass media, to the public the concept of the new practice.
        (a) In upgrading the professional quality, in the period between 1993 and 1996, national professional associations had been asked to organize continuing education programs and workshops for pharmacists. One course under this continuing education program was for 40 hours: 28 hours of lectures and 12 hours for practice in dispensing. A total of 5,844 pharmacists had been trained. A certificate of continuing education was issued to each.
        (b) To provide patients with better counseling on drug use, computer programs were arranged to encourage and help the establishment of database on the drug use of patients and the contents of prescriptions at the periodical meetings with   community pharmacies in each county. To ensure that the medicines supplied by the community pharmacies meet the
     demands of clinics, pharmaceutical associations have been financially supported to handle the problems of rarely used medicines. In the future, community pharmacies and the pharmacy departments of teaching hospitals will be connected for clinical pharmacology and dispensing practices, and some supporting centers will be set up in the northern, central
     and southern parts of the island to meet the professional needs of these pharmacies under contract.
        (c) A CIS (Corporate Identification System) stressing "care and professional service" will be established; signboards of pharmacies will be standardized; a VI system will be set up; and all pharmacies will have relatively standardized management and service models.
        (d) More educational activities will be organized. Relevant associations and local health agencies will be asked to   organize educational activities on special occasions. Pamphlets, posters and videos will be produced for showing on radios and TV's, in hospitals and at public places. Important concepts to be advocated include: "Patients are entitled to ask doctors for prescriptions and to have them dispensed at any pharmacies they choose"; "the two logos of the pharmacies under contract with the National Health Insurance Program"; "service contents of pharmacies under contract with the National Health Insurance"; "no additional payment when the prescription is filled in one of these pharmacies"; and "the dispensing practice regulations for prescription of chronic illness".

(2) Community pharmacies will be supervised to become contracted pharmaciesunder the National Health Insurance Program. On 1 June 1995, contracted pharmacies under the National Health Insurance Program started. By the end of 1995, there were 808 such pharmacies. To promote this new practice, the pharmacist and the assistant pharmacist associations have been asked to plan for the target number of these pharmacies to be established by stages.

(3) Laws and regulations have been amended accordingly. On 5 February 1993, Item 2 of Article 102 of the Law of Pharmaceutical Affairs was amended to include in the Law provisions that the separation of dispensing practice from medical practice would take place two years after the implementation of the National Health Insurance Program. Article 55 of the National Health Insurance Law promulgated on 9 August 1994 stipulates that contracted pharmacies under the Insurance will be a part of the medical care delivery system. These provisions clearly define the role of the pharmacies under special contract in providing the insured public with dispensing services. On 21 September 1994, a set of guidelines for GDP (good dispensing practice) and for the continuing education of pharmaceutical personnel of the pharmacies under special contract were announced to standardize the dispensing practice.

2). The Prospects
To promote the new practice and to expedite the growth of pharmacies under special contract, local health agencies have been asked to organize, in collaboration with local pharmacist and assistant pharmacist associations, promotion committees for the new practice to decide on the target number of pharmacies to be established and to help in the signing of contracts. The Department has also established, by inviting representatives of local health agencies, the Bureau of National Health Insurance, the medical association, the pharmacist and the assistant pharmacist associations, experts in public health and medical sciences, and the consumers, a committee for the separation of dispensing practice from medical practice to plan for strategies to actively promote the new practice and thus to provide the public with more convenient and safe services of drug use.

Source: http://www.doh.gov.tw/english/ch6_f.html#sectionFive

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ABSTRACT

Key words: The separation of dispensing practice from medical practice, Release of prescription, Medication claims

The implementation of The Separation of Dispensing Practice from Medical Practice (SDPMP) began in March of 1997 and led to heated dispute between physicians and pharmacists. Now, people seem to be quieter about this issue. Do these mean that opinions of the two professional groups are getting closer and people understand the policy better? Or they just find a way to cope with the change? Our study will try to answer these questions with objective data collected in Taipei City.

The specific aims are: (1) To understand common peoples knowledge and attitudes toward SDPMP and their satisfaction. (2) To investigate then Influence of SDPMP on common peoples medication experiences. (3) To evaluation the effect of SDPMP on physicians release of prescriptions and prescriptions for chronic disease. (4) To evaluation the effect of SDPMP on pharmacists and community pharmcies services. (5) To understand how physicians and common people cope with the medicine fare co-payment policy. (6) To compare pre- and post- SDPMP overall medication claims, and expenditure increment.

Questionnaire survey and National Health Insurance data were analized.

Results showed that: (1) Most common people understand what the SDPMP is about and support the policy. More than 30% of people feel the Improvement of medication safety and pharmcists services after the Implementation of SDPMP. (2) SDPMP had effect on Increase of prescriptions releasing at the beginning of the policy Implementation. It did not help the community pharmacies business. However, It did help to emphasize pharmacists professional Image. (3) Medicine fare co-payment policy had no signification effect on releasing prescriptions. It is suggested that the policy maker should pay more attention to strategies that can reduce the conflict between physicians and pharmacists, increase the convenience of getting the prescribed medicine and standardize drugs prices for better SDPMP effects.

Source: http://www.nhi.gov.tw/research/88pln025.htm

Last modified: 14/08/01