Abstract
The Universal Coverage Scheme (UCS) medicine delivery initiative, as known as "Take
medicine near home" program, has been operational since late 2019, supported by the
National Health Security Office (NHSO) through project initiation funding and compensation
for hospitals and pharmacists. In the initiative, patient registered with the UCS can pick up
refilled medicine for chronic diseases from pharmacies near their home, with their hospitals
arrangement. During the COVID-19 pandemic in 2020 and 2021, the program gained
popularity due to limited access to hospital services. However, since 2022, usage has
declined significantly as COVID-19 restrictions eased, hospitals found the program less
effective in reducing workload and congestion, and patients preferred UCS provided home
delivery service.
The research team collected data through field visits, observations, and interviews with
hospital staff and pharmacists in community pharmacies from various provinces participating
in three models of the UCS medicine delivery initiative:
Model 1 is the model that hospital prepare, pack and deliver prescribed medicine to
community pharmacies which dispense to patients. Hospitals participated in Model 1
are composed of Chiang Rai, Chiang Mai, Lamphun, Khon Kaen, Nakhon Ratchasima,
Chonburi, and Bangkok
Model 2 is the model that hospital delegate medication stock to community
pharmacies which prepare, pack and dispense as hospital prescription. Hospital
participated in Model 2 is Phichit
Model 3 is the model that hospital solely transfer prescription information to community
pharmacies which perform sourcing, inventory management and dispensing. Hospitals
participated in Model 3 are composed of Songkhla and Phatthalung
Data collection occurred from October 2022 to December 2023, supplemented by secondary
data on medication dispensing and distribution from participating hospitals and community
pharmacies.
Key Findings:
1. Model 1 (Chiang Rai, Chiang Mai, Lamphun, Khon Kaen, Nakhon Ratchasima, Chonburi,
and Bangkok):
1.1 Few hospitals in these provinces still maintained a reasonable level of medication
dispensing through UCS medicine delivery initiative in 2022. However, hospitals
lacking following factors experienced a significant drop in program participation. For
the hospitals that are able to maintain the program, success factors included:
- A simple patient screening process.
- An integrated information system linking clinical data with community
pharmacies.
- A wide range of eligible medications and diseases.
2. Model 2 (Phichit Province):
2.1 Only one hospital with few community pharmacies participate in this model.
Community pharmacies handled delegated inventory management and dispensing.
However, the program’s scope was limited due to a small range of eligible
medications and diseases. This model is not well adopted due to burden of
inventory management and regulatory requirement.
3. Model 3 (Songkhla and Phatthalung Provinces):
3.1 Songkhla (Hat Yai) had three months of program implementation, while Phatthalung
participated for less than a month. Community pharmacies participating this model
expressed concerns about procurement costs and potential losses from NHSO
reimbursement rates. Our economic analysis suggested better cost-effectiveness with
larger medication prescription. Furthermore, proper distributer or logistics provider
would be key success factor in this model.
Interviews Summary:
All Community Pharmacists from all program models showed a positive attitude toward the
program. They appreciate the opportunity to use their professional knowledge. They were
generally willing to absorb transportation costs and did not consider NHSO’s per-head
compensation a primary motivating factor.
Conclusion:
Model 1 saw a significant decline in participation since 2022. Transitioning to Model 3 could
help hospitals reduce workload and congestion, but critical success factors include:
- Suitable distributors or logistics providers.
- Reasonable price margins between pharmacy procurement costs and NHSO
reimbursement rates.
- A sufficiently large range of medications, conditions, and prescriptions.
Additionally, the research team developed a tool to help hospitals estimate the appropriate
number of participating pharmacies to support the program’s future implementation.
