Objective: To measure willingness to pay (WTP) for pharmacists' services directed toward reducing the risk of medication-related problems and to determine factors that have a significant influence on WTP.
Design: WTP was measured using a contingent valuation. Respondents' WTP through ex post (out of pocket) and ex ante (insurance premium) methods were measured using three hypothetical scenarios illustrating reductions in the risk of medication-related problems. Logistic regression and semi log regression were performed to evaluate the responses to the survey
Setting: Out patient clinic of Robert Wood Johnson University Hospital and two physician offices located in New Jersey.
Participants: A convince sample of 316 patients and/or family members who visited the study site between March 1 and September 15, 1999, were included.
Main Outcome Measures: Amounts patients were willing to pay out of pocket or through insurance premiums for pharmacists' services.
Results: The mean WTP out of pocket for pharmacy services ranged from
$4.02 to $5.48 per prescription, depending on the level of risk reduction. Mean
WTP through increased insurance premium ranged from $28.79 to $36.29 per year.
Overall, the average WTP for a pharmacist's consultation was $5.57, and WTP
increased by $0.87 as counseling time increased by 1 minute. WTP was sensitive
to changes in the magnitude of risk reduction in both ex post and ex ante scenarios.
Income was positively related to WTP, but not to the level of statistical significance.
Conclusion: Respondents were willing to pay for pharmacists' services that refuse the risk of medication-related problems. Additional investigations determine the factors that influence WTP for health care professionals' services are warranted.
Whenever a prescription drug is given to a patient a medication-related problem
may result. Estimates of the annual economic burden of such medication-related
morbidity and morality in the ambulatory setting range from $30 billion to $130
billion in the United States. Adverse drug reactions are strongly correlated
with longer hospital stays and result in higher hospitalization costs. The latter
range from $2,262 to $3,244 per adverse drug event.
Pharmacists are in a unique and powerful position within the healthcare system.
They can offer a wide range of needed services to patients, including consolation
about medication therapy, detection and resolution of medication-related problems,
patient education, and therapeutic monitoring. Moreover, pharmacists have a
social responsibility to identify, prevent, and correct medication-related morbidity
as well as to provide pharmaceutical products to the public. Johnson and Bootman
estimated that the provision of pharmacy services in ambulatory care pharmacy
settings could reduce negative therapeutic outcomes by 53% to 63 %.
Despite fervent attempts to increase the community pharmacist's role in health care, several major obstacles often preclude delivery of pharmaceutical care. The lack of reimbursement for clinical services is the most common explanation pharmacists give when asked about their failure to deliver cognitive services. Heavy workloads often result in insufficient time for adequate use of pharmacists' clinical skills.
Several methods for empirical valuation of health care services have been developed,
but the technique most widely used in cost effectiveness analysis. Unfortunately,
the use of cost effectiveness analysis is limited to aiding in the selection
among alternative treatments for a single condition in an effort to maximize
the effectiveness of a given budget, because it does not measure consumers'
preferences for trade-offs between costs and outcomes.