Abstract
Objectives: This study aimed to (1) survey pharmacy service models for reducing hospital
overcrowding, (2) analyze the cost-benefit of various pharmacy services compared to
conventional outpatient pharmacy dispensing from hospital and societal perspectives, (3)
estimate the budget impact of these services over a 5-year period from the Universal Health
Coverage perspective, and (4) develop policy recommendations for pharmacy services to
reduce hospital overcrowding.
Methods: This study used secondary data from six tertiary care hospitals under the Permanent
Secretary of the Ministry of Public Health: Lamphun, Udon Thani, Saraburi, Phrachomklao
Phetchaburi, Ranong, and Krabi Hospitals in fiscal year 2024. The study was conducted in four
phases: (1) surveying service models through Google Forms and literature review from the
ThaiJo database covering 10 years (2013-2024), (2) analyzing cost-benefit using a decision tree
model by calculating net present value (Net present value; NPV) and benefit-cost ratio
(Benefit-cost ratio; BCR) with one-way sensitivity analysis, (3) estimating budget impact over 5
years (2026-2030), and (4) conducting a stakeholder consultation meeting. All cost data were
adjusted to 2024 values using the Consumer Price Index (CPI).
Results: Six main pharmacy service models for reducing overcrowding were identified: postal
medicine delivery, Health Rider, pharmacy pick-up (Model 3), Telepharmacy, Lean process
improvement, and automated drug dispensing systems. However, service utilization remained
low (not exceeding 3% of outpatient prescriptions). From the hospital perspective,
conventional outpatient pharmacy dispensing had a unit cost of 59.33 baht, while postal
delivery and Health Rider services cost 94.64 baht, and Telepharmacy cost 35.31 baht per
unit. All services had negative NPV (ranging from -85.31 to -20.32 baht) and BCR below 1,
indicating lack of cost-effectiveness for hospitals. However, from the societal perspective, most
services had NPV equal to 0, indicating cost neutrality due to patient savings in transportation
costs, parking fees, and waiting time. Sensitivity analysis revealed that increasing
reimbursement to 100 baht per service would make medicine delivery services cost-effective,
and including Telepharmacy as a benefit at 50 baht per service would be highly cost-effective
(BCR = 1.10). The budget impact of expanding services to cover 20% of outpatient prescriptions
in 35 tertiary hospitals by 2030 would require over 214 million baht annually, increasing to
321-428 million baht if reimbursement rates are adjusted to 100 baht per service.
Conclusions: Pharmacy services for reducing hospital overcrowding are cost-effective from
the societal perspective but not from the hospital perspective at current reimbursement rates.
Key policy recommendations include: (1) adjusting reimbursement rates from 50 to 75-100
baht per service, (2) including Telepharmacy as a reimbursable benefit at 50 baht per service,
(3) setting realistic targets starting at 10-15% coverage within 2-3 years, (4) supporting
investment in technology systems and personnel development, and (5) developing systematic
monitoring and evaluation systems. Implementation of these recommendations will
contribute to service sustainability and development of an accessible, quality, and equitable
health system for all citizens
