Behind the counter: a time-driven activity-based costing analysis of community pharmacy dispensing services in Taiwan

Sustainable financing of community pharmacy services requires reimbursement models that accurately reflect resource use. However, empirical cost data for dispensing services remain limited in many health systems, including Taiwan's single-payer National Health Insurance (NHI) program. This study estimated the cost of dispensing services in community pharmacies and assessed the extent to which current reimbursement reflects underlying resource utilization.

A cost analysis was conducted from the healthcare provider perspective using a time-driven activity-based costing approach. Eight community pharmacies in Taiwan were included. Dispensing workflows were systematically mapped into six sequential steps, and time-and-motion data were collected across six simulated standardized dispensing scenarios designed to capture variation in medication number and type. Resource use included direct, indirect, and personnel-related cost components. Indirect costs were allocated using both space-based and revenue-based approaches. Personnel costs were calculated using capacity cost rates based on pharmacist salaries and practical working capacity. All costs were expressed in New Taiwan Dollars (NT$), and sensitivity analyses assessed robustness under alternative allocation assumptions.

Mean dispensing time ranged from 195 to 303 s per prescription and increased with prescription complexity. Total dispensing costs ranged from NT$30.82 to NT$61.21 per prescription. Each additional medication increased costs by NT$13-17, while controlled substances added NT$18-23 due to additional regulatory procedures. Personnel-related costs were the primary cost driver, and cognitive verification activities accounted for the largest share of workload. Compared with current NHI dispensing reimbursement of approximately NT$49-68 per prescription, reimbursement may inadequately reflect the resources required for more complex prescriptions. Cost patterns were consistent across allocation methods.

Dispensing services are resource-intensive and vary with prescription complexity, yet current flat-fee reimbursement under Taiwan's NHI does not adequately reflect this variation. Complexity-adjusted reimbursement mechanisms, such as per-medication or controlled-substance modifiers, may better align payment with actual resource utilization and support sustainable community pharmacy services.