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UKOM Sp.F.M study materials
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UKOM Sp.F.M practice questions

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Question 1Pharmacy management and leadership

A community pharmacy wants to introduce a new repeat-prescription collection service. According to the principles of change management, which action should the pharmacist manager take first?

  1. Assign one technician to run the service without wider consultation
  2. Reward the staff who adopt the new workflow most quickly
  3. Create a sense of urgency by sharing data on current waiting times and errors Correct answer.
  4. Announce the final standard operating procedure to all staff by email

Explanation

Kotter's model of change begins with establishing a sense of urgency so that staff understand why the change matters before any process is designed. Sharing concrete local data on waiting times and dispensing errors creates that shared motivation. Announcing a finished SOP or rewarding early adopters comes later in the change cycle.

Question 2Pharmacy management and leadership

During a busy dispensary session, a pharmacist delegates the final accuracy check of dispensed items to a trained pharmacy technician. Which statement best describes the professional position?

  1. Accountability transfers to the superintendent pharmacist because the task was delegated
  2. Delegation of the accuracy check removes the pharmacist's legal responsibility entirely
  3. The technician becomes professionally accountable once the check is completed
  4. The pharmacist retains accountability for the clinical appropriateness and safety of the supply Correct answer.

Explanation

Delegation transfers the task but not the accountability; the registered pharmacist remains answerable for the safety and clinical appropriateness of what is supplied. The technician is accountable for performing the delegated task competently, not for the overall clinical decision. Accountability for the service ultimately sits with the registrant responsible for that activity.

Question 3Pharmacy management and leadership

A pharmacy manager is setting up a small quality-improvement project to reduce near-miss dispensing errors. Which approach best reflects the Plan-Do-Study-Act cycle?

  1. Collect twelve months of baseline data before making any change at all
  2. Roll out the change to every branch simultaneously and review after one year
  3. Test a small change, measure its effect, interpret the results, then adapt before wider rollout Correct answer.
  4. Write a policy, audit compliance annually, and discipline staff who deviate from it

Explanation

PDSA is an iterative method in which a change is trialled on a small scale, measured, studied and then adapted or scaled. This rapid cycling builds evidence and learning before wider implementation. Large simultaneous rollouts and long data-collection phases are not characteristic of PDSA.

Question 4Pharmacy management and leadership

A pharmacist manager is preparing a business case for an additional pharmacist cover shift. Which financial concept should be used to compare the total cost of the new shift against the expected reduction in error-related costs over the year?

  1. Break-even point in units
  2. Working capital ratio
  3. Gross margin per prescription
  4. Return on investment Correct answer.

Explanation

Return on investment compares the net benefit of an investment with its cost, which is exactly what is needed when weighing extra staffing against avoided error-related expenditure. Gross margin and break-even in units address product profitability and volume, not the value of a service investment. Working capital ratio is a liquidity measure.

Question 5Pharmacy management and leadership

A pharmacy manager notices that one experienced dispenser consistently works faster but makes more selection errors when the queue is long. Which leadership response best reflects situational leadership theory?

  1. Adapt supervision and support to the individual's competence and the demands of the situation Correct answer.
  2. Increase the individual's workload to build resilience under pressure
  3. Apply the same directive supervision to all staff regardless of experience
  4. Refer the matter straight to formal capability procedures

Explanation

Situational leadership holds that the leader should flex style according to the follower's competence and commitment and the demands of the task. A capable but error-prone-under-pressure dispenser needs closer monitoring and support during peak periods rather than uniform treatment. Escalating to capability procedures is disproportionate at this stage.

Question 6Pharmacy management and leadership

Which activity is the clearest example of clinical governance in a community pharmacy?

  1. Posting health-promotion leaflets near the entrance
  2. Scheduling annual leave to cover the summer holiday period
  3. Negotiating a lower wholesale price for a fast-moving over-the-counter line
  4. Establishing a system for reporting and reviewing patient safety incidents with learning actions Correct answer.

Explanation

Clinical governance is the framework through which organisations assure and improve the quality and safety of care, and incident reporting with structured learning is a core component. Pricing negotiation, rota planning and leaflet display are operational or commercial activities. They do not by themselves create assurance or learning about clinical quality.

Question 7Pharmacy management and leadership

A pharmacist is asked to lead a team meeting where two staff members have an ongoing interpersonal conflict that is affecting workflow. Which approach is most consistent with effective conflict management?

  1. Avoid raising the conflict so that the team can focus on dispensing targets
  2. Facilitate a structured conversation focused on behaviours and shared goals Correct answer.
  3. Separate the two staff permanently without discussing the issue
  4. Tell the more junior staff member to concede to resolve the matter quickly

Explanation

Constructive conflict management addresses the issue directly, focusing on behaviours and shared objectives rather than personalities. A facilitated conversation allows both parties to be heard and agree a way forward. Avoidance, forced separation or instructing one party to concede leaves the underlying problem unresolved.

Question 8Pharmacy management and leadership

A pharmacy manager is designing a rota for a seven-day opening. Which principle best supports safe staffing decisions?

  1. Rely on a single locum pharmacist for all weekend cover
  2. Prioritise staff preferences over anticipated workload patterns
  3. Match skill mix and numbers to predicted workload and patient acuity for each shift Correct answer.
  4. Ensure every shift has the same number of staff regardless of demand

Explanation

Safe staffing requires that the number and skill mix of staff are aligned to the anticipated workload and acuity of patients at each time. Uniform staffing regardless of demand risks both under- and over-provision. Staff preference and single-person reliance are secondary considerations that can compromise safety.

Question 9Pharmacy management and leadership

A pharmacy manager wishes to develop a colleague who shows potential for a team-leader role. Which intervention is most consistent with a coaching approach?

  1. Postpone development until a vacancy actually arises
  2. Assign the colleague extra dispensing duties to build stamina
  3. Use structured questioning to help the colleague identify their own development goals and actions Correct answer.
  4. Tell the colleague exactly which course to complete and monitor attendance

Explanation

Coaching uses questioning and reflection to help the individual generate their own insight, goals and actions, which builds ownership and capability. Directive instruction and extra routine duties do not develop leadership capacity. Deferring development until a vacancy appears is reactive rather than developmental.

Question 10Pharmacy management and leadership

A pharmacy has introduced a new electronic prescription tracking system. Several staff members continue to use the old paper log. Which action is most likely to improve sustained adoption?

  1. Remove the paper log without explanation or training
  2. Monitor compliance and report non-users to the superintendent
  3. Issue a written instruction that the paper log must not be used
  4. Involve staff in refining the new system and address the practical reasons they revert to paper Correct answer.

Explanation

Sustained adoption depends on engagement and on removing the practical barriers that make the old method attractive. Involving users in refinement builds ownership and surfaces real workflow problems. Simple prohibition, unexplained removal or punitive reporting tends to produce compliance without commitment.

Question 11Pharmacy management and leadership

Which of the following best describes the purpose of a root cause analysis following a dispensing error?

  1. To calculate the financial cost of the incident
  2. To determine which individual should be disciplined
  3. To satisfy insurance requirements after a claim
  4. To identify underlying system failures and prevent recurrence Correct answer.

Explanation

Root cause analysis is a systems-based method that looks beyond the individual to the underlying process and environmental factors that allowed the error. Its purpose is learning and prevention rather than blame, cost calculation or insurance compliance. Focusing on individual discipline tends to suppress reporting.

Question 12Pharmacy management and leadership

A pharmacist manager is asked to produce a SWOT analysis before launching a new travel-vaccination clinic. Which pairing correctly reflects the SWOT framework?

  1. Strengths and opportunities are internal; weaknesses and threats are external
  2. Strengths and threats are internal; weaknesses and opportunities are external
  3. Strengths and weaknesses are internal factors; opportunities and threats are external Correct answer.
  4. All four categories are external environmental factors

Explanation

SWOT separates internal attributes of the organisation, namely strengths and weaknesses, from external environmental factors, namely opportunities and threats. This distinction matters because internal factors can be influenced directly while external ones must be anticipated and adapted to. The other pairings misclassify the categories.

Question 13Pharmacy management and leadership

A pharmacy manager wants to reduce the risk of a single pharmacist being the only person able to run the controlled-drugs register. Which workforce strategy addresses this directly?

  1. Reducing the frequency of register checks
  2. Cross-training additional staff and documenting the process as a standard operating procedure Correct answer.
  3. Increasing the salary of the current register holder
  4. Restricting register access to the superintendent pharmacist

Explanation

Cross-training and documented procedures reduce key-person dependency by spreading capability and making the process transferable. Pay increases, reduced checks and narrower access all increase rather than reduce reliance on a single individual. Documented SOPs also support consistency and auditability.

Question 14Pharmacy management and leadership

During a team briefing, a pharmacist manager gives specific feedback to a dispenser about labelling accuracy. Which feedback approach is most effective?

  1. Give general praise and avoid mentioning the labelling problem
  2. State that the dispenser is careless and must improve immediately
  3. Delay feedback until the next annual appraisal
  4. Describe the observed behaviour, its impact and the expected standard, and invite a response Correct answer.

Explanation

Effective feedback is specific, behavioural and timely, linking the observed action to its impact and the expected standard while inviting dialogue. Personal criticism, vague praise or long delay all reduce the value of the feedback and can damage trust. Inviting a response also supports a two-way conversation.

Question 15Pharmacy management and leadership

A pharmacy manager is reviewing monthly dispensing figures and notices a sustained rise in the proportion of prescriptions returned to the prescriber for clarification. Which interpretation is most appropriate?

  1. A clinical outcome indicator proving that patient care has deteriorated
  2. A financial indicator showing that profitability has fallen
  3. A process indicator suggesting a need to review prescription screening and communication with prescribers Correct answer.
  4. A staff satisfaction indicator requiring a wellbeing survey

Explanation

The proportion of prescriptions queried is a process indicator of how well screening and prescriber communication are working. It points to a review of workflow and communication rather than directly proving clinical outcomes or financial effects. Interpreting it as a staff satisfaction signal confuses unrelated domains.

Question 16Pharmacy management and leadership

A pharmacist manager must decide how to allocate a limited training budget. Which criterion best aligns with a risk-based approach?

  1. Fund the training most requested by staff regardless of risk
  2. Prioritise training that addresses the highest-likelihood and highest-impact patient safety risks Correct answer.
  3. Spread the budget equally across all staff and topics
  4. Fund training that is easiest to arrange at short notice

Explanation

Risk-based prioritisation directs limited resources toward the hazards with the greatest likelihood and impact on patient safety. Equal spreading, popularity and convenience are not risk criteria and may leave serious vulnerabilities unaddressed. This approach is consistent with governance expectations for proportionate resource use.

Question 17Pharmacy management and leadership

Which statement best explains the role of a standard operating procedure in pharmacy management?

  1. It is only required for controlled-drug transactions
  2. It guarantees that errors will not occur in that process
  3. It replaces the need for staff training and competence assessment
  4. It documents the agreed process so that work is performed consistently and can be audited Correct answer.

Explanation

An SOP documents the agreed way of carrying out a process, supporting consistency, training and auditability. It does not replace competence assessment, cannot guarantee error-free work, and is relevant to many processes beyond controlled drugs. SOPs are tools that support safe practice rather than substitutes for it.

Question 18Pharmacy management and leadership

A pharmacy manager is introducing a new prescription-handling workflow. Some staff argue that the existing method is safer. Which leadership behaviour best supports a constructive resolution?

  1. Invite the concerns, examine the evidence for both methods, and agree a trial with review Correct answer.
  2. Insist on the new workflow because the manager has authority
  3. Defer the decision indefinitely until everyone agrees
  4. Allow each staff member to choose whichever method they prefer

Explanation

Inviting concerns and weighing evidence demonstrates respect for staff expertise and builds a shared basis for the decision. A time-limited trial with review allows the team to test claims and adapt. Relying on authority, permitting inconsistent practice or indefinite deferral all undermine safety and consistency.

Question 19Pharmacy management and leadership

A pharmacist manager is preparing to recruit a new accuracy-checking technician. Which element contributes most to a fair and defensible selection process?

  1. Selecting the candidate who is personally known to the manager
  2. Choosing the candidate who accepts the lowest salary
  3. Using predefined, job-related criteria applied consistently to all candidates Correct answer.
  4. Basing the decision mainly on the first impression at interview

Explanation

Fair selection relies on predefined criteria that are clearly related to the job and applied consistently to every candidate. Familiarity, first impressions and salary alone introduce bias and are not valid predictors of competence. Structured, job-related assessment also supports defensibility if a decision is challenged.

Question 20Pharmacy management and leadership

A pharmacy manager notices that incident reports have fallen sharply even though workload has increased. Which interpretation should prompt further investigation?

  1. A falling reporting rate may reflect under-reporting rather than improved safety Correct answer.
  2. A falling reporting rate means the reporting system should be withdrawn
  3. A falling reporting rate is irrelevant to safety management
  4. A falling reporting rate always proves that safety has improved

Explanation

Reporting rates are influenced by culture as well as by safety, and a sharp fall during rising workload may signal fear, fatigue or disengagement rather than genuine improvement. Safety management therefore requires triangulation with other data such as near-miss logs and staff feedback. Assuming improvement or withdrawing the system would be unsafe conclusions.

Question 21Pharmacy management and leadership

A pharmacist manager in a small independent pharmacy wants to improve capacity without increasing total staff hours. Which approach best reflects lean thinking?

  1. Increase stock holdings of every product to avoid any waiting
  2. Identify and remove non-value-adding steps and bottlenecks in the dispensing workflow Correct answer.
  3. Reduce the number of accuracy checks performed
  4. Ask staff to work faster during peak periods

Explanation

Lean thinking focuses on eliminating waste, meaning activity that does not add value for the patient, and on relieving bottlenecks to improve flow. Urging speed, cutting safety checks or indiscriminately increasing stock addresses symptoms and can introduce risk. Removing non-value-adding steps improves capacity without extra hours.

Question 22Pharmacy management and leadership

A pharmacy manager is mentoring a newly qualified pharmacist who is anxious about making clinical decisions. Which approach best reflects the concept of a 'safe space to learn'?

  1. Assign the pharmacist the most complex cases to build confidence quickly
  2. Restrict the pharmacist to administrative tasks until fully confident
  3. Review the pharmacist's every decision publicly in team meetings
  4. Encourage graduated responsibility with available support and non-punitive discussion of mistakes Correct answer.

Explanation

A safe learning environment provides graduated responsibility with accessible support and treats errors as learning opportunities rather than grounds for blame. Overloading with complexity, excluding from clinical work or public scrutiny all increase anxiety and reduce learning. Psychological safety is central to developing confident, competent practitioners.

Question 23Pharmacy management and leadership

A pharmacy manager is comparing two suppliers for a high-volume generic medicine. Which consideration is most directly relevant to supply-chain resilience?

  1. The supplier's social media following
  2. The supplier's lead times and track record of reliable delivery Correct answer.
  3. The colour of the supplier's packaging
  4. The supplier's marketing budget for the product

Explanation

Supply-chain resilience depends on reliable delivery and predictable lead times, which determine whether stock shortages are avoided. Marketing budget, packaging colour and social media presence do not affect the ability to maintain supply. Resilience planning focuses on reliability and contingency.

Question 24Pharmacy management and leadership

A pharmacist manager receives a complaint that a patient waited over an hour for a prescription. Which first step best reflects a systematic approach to complaint handling?

  1. Acknowledge the complaint, investigate the actual process and causes, and respond with actions taken Correct answer.
  2. Offer a refund immediately to close the complaint without investigation
  3. Explain to the patient that delays are unavoidable at busy times
  4. Refer the complaint to the regulator without any local review

Explanation

Good complaint handling acknowledges the concern, investigates the real process and causes, and responds with the actions taken to prevent recurrence. Immediate refunds without investigation, dismissive explanations or premature escalation all fail to address the underlying issue. Local learning is central to improvement.

Question 25Pharmacy management and leadership

A pharmacy manager is designing a dashboard to monitor service quality. Which set of measures best reflects a balanced approach?

  1. Safety, patient experience, timeliness and staff wellbeing indicators Correct answer.
  2. Only the financial gross profit per month
  3. Only the number of prescriptions dispensed per hour
  4. Only the number of complaints received

Explanation

A balanced dashboard combines safety, patient experience, timeliness and workforce measures so that improvement in one area is not achieved at the expense of another. Single measures such as throughput, profit or complaints alone give a partial and potentially misleading picture. Balance supports sound managerial judgement.

Question 26Pharmacy management and leadership

A community pharmacy is introducing a new service for medicines use reviews. Which management approach best ensures that all staff understand their responsibilities and the service is delivered consistently?

  1. Develop a standard operating procedure (SOP) that defines each step and role, and train staff on it. Correct answer.
  2. Ask each pharmacist to use their own preferred method for the review.
  3. Delegate the entire service design to the newest staff member to encourage learning.
  4. Rely on informal verbal instructions passed between staff as needed.

Explanation

An SOP provides a written, consistent framework that clarifies roles and steps, reducing variation and supporting safe, reproducible practice. Training staff on the SOP ensures everyone understands and follows the agreed process. This is a core element of pharmacy management for quality and risk control.

Question 27Pharmacy management and leadership

A pharmacy manager is preparing a business case to extend opening hours. Which tool is most appropriate for identifying the internal strengths and weaknesses of the pharmacy alongside external opportunities and threats in the local market?

  1. A root cause analysis.
  2. A SWOT analysis. Correct answer.
  3. A Pareto chart.
  4. A fishbone diagram.

Explanation

SWOT analysis is a strategic planning tool that examines internal strengths and weaknesses and external opportunities and threats. It helps managers assess the feasibility of a change such as extended hours in the context of the pharmacy's capabilities and the local environment. Other tools listed are primarily for quality improvement or problem-solving.

Question 28Pharmacy management and leadership

A pharmacist manager notices that a newly implemented dispensing robot has reduced dispensing speed instead of increasing it. Staff are frustrated and some are bypassing the robot. Which action best demonstrates effective change management?

  1. Gather staff feedback to understand the causes of the slowdown and involve them in refining the workflow. Correct answer.
  2. Remove the robot and revert to the previous manual process immediately.
  3. Extend the robot's use to all prescriptions regardless of the current issues.
  4. Reinforce the rule that staff must use the robot and monitor compliance.

Explanation

Effective change management involves engaging staff, listening to their concerns, and addressing the root causes of resistance or difficulty. Involving staff in refining the workflow builds ownership and can resolve the slowdown. Simply enforcing compliance or reverting without analysis misses the opportunity to improve.

Question 29Pharmacy management and leadership

A pharmacy manager is reviewing the team's performance and wants to foster a culture of continuous improvement. Which approach is most likely to encourage staff to identify and report near misses?

  1. Implementing a blame-free reporting system with feedback on improvements made. Correct answer.
  2. Punishing staff who report near misses to deter future errors.
  3. Requiring staff to report near misses only to their direct supervisor verbally.
  4. Ignoring near misses unless they result in patient harm.

Explanation

A blame-free reporting system encourages transparency and learning from near misses, which are valuable opportunities to identify system weaknesses. Providing feedback on improvements shows staff that their reports lead to positive change, reinforcing the culture. Punitive or informal approaches discourage reporting and miss learning opportunities.

Question 30Pharmacy management and leadership

A pharmacy manager is analyzing the financial performance of the dispensary. The gross profit margin has declined over the past year despite stable sales revenue. Which factor is most likely to explain this trend?

  1. An increase in the cost of goods sold without a corresponding increase in selling prices. Correct answer.
  2. A decrease in the number of staff employed in the dispensary.
  3. A reduction in operating expenses such as utilities.
  4. An increase in the number of prescriptions dispensed at the same average price.

Explanation

Gross profit margin is calculated as (revenue minus cost of goods sold) divided by revenue. If sales revenue is stable but the cost of goods sold rises, the margin will decline. Operating expenses, staff numbers, and prescription volume at the same price do not directly affect gross margin in the same way.

Question 31Pharmacy economics and health financing

A hospital pharmacy in Indonesia is reimbursed under the INA-CBG case-mix system. Which payment logic does this scheme follow?

  1. Capitation per enrolled member per month
  2. Cost-based reimbursement of actual expenditure
  3. Fee-for-service per dispensed item
  4. Prospective payment grouped by diagnosis and procedure Correct answer.

Explanation

INA-CBG is a prospective case-mix system: patients are grouped into diagnosis-related groups and the hospital receives a fixed tariff for the episode regardless of the actual resources consumed. Because the tariff is fixed in advance, the provider bears the financial risk of cost overruns.

Question 32Pharmacy economics and health financing

Which definition best describes moral hazard in health insurance?

  1. Insurers select low-risk enrollees to reduce claims
  2. Insured persons use more services because the marginal cost to them falls Correct answer.
  3. Premiums rise as healthier members leave the pool
  4. Providers charge different prices to insured and uninsured patients

Explanation

Moral hazard arises when insurance lowers the price a patient faces at the point of use, so consumption of care increases beyond what would occur if the full price were paid. Cost-sharing such as copayments is designed to dampen this effect.

Question 33Pharmacy economics and health financing

In pharmacoeconomic evaluation, what distinguishes a cost-utility analysis from a cost-effectiveness analysis?

  1. It always adopts a societal perspective
  2. It reports outcomes only in natural clinical units
  3. It uses a preference-weighted outcome such as the QALY Correct answer.
  4. It excludes costs of adverse events from the analysis

Explanation

Cost-utility analysis expresses health gain as a preference-weighted metric, most commonly the quality-adjusted life year, which combines length of life with health-related quality of life. Cost-effectiveness analysis instead uses a single natural clinical endpoint such as mmHg or life-years gained.

Question 34Pharmacy economics and health financing

A pharmacy calculates its inventory turnover ratio as cost of goods sold divided by average inventory value. Which change would increase the ratio, all else equal?

  1. Reducing the average value of stock held Correct answer.
  2. Increasing the number of slow-moving items
  3. Raising the retail mark-up on fast movers
  4. Extending supplier payment terms

Explanation

Inventory turnover measures how many times stock is sold and replaced over a period, so a smaller average inventory value for the same cost of goods sold raises the ratio. Higher turnover generally signals less capital tied up in stock and lower holding costs.

Question 35Pharmacy economics and health financing

Which statement correctly describes a reference pricing policy for pharmaceuticals?

  1. Prices are set equal to the average of all registered products in the class
  2. Reimbursement is refused for all products in a therapeutic class
  3. The payer reimburses up to a benchmark price, with patients paying any excess Correct answer.
  4. The manufacturer sets any price above a fixed international floor

Explanation

Under reference pricing the payer sets a maximum reimbursement level based on a benchmark, often the price of comparable medicines in the same group. Products priced above the reference require the patient to pay the difference, which creates pressure on manufacturers to lower prices.

Question 36Pharmacy economics and health financing

A national health insurance scheme covers a defined benefit package financed mainly from payroll contributions, with the government paying contributions for the poor. Which financing arrangement does this describe?

  1. Out-of-pocket financing
  2. Social health insurance Correct answer.
  3. Medical savings accounts
  4. Private voluntary health insurance

Explanation

Social health insurance pools mandatory contributions, usually linked to earnings, to fund a defined benefit package, and commonly includes government subsidies for low-income groups. Indonesia's JKN scheme is a well-known example of this model.

Question 37Pharmacy economics and health financing

A pharmacy's fixed costs are IDR 60 million per month and its variable cost per prescription is IDR 20,000. If the average revenue per prescription is IDR 50,000, what monthly prescription volume is required to break even?

  1. 1,500 prescriptions
  2. 1,200 prescriptions
  3. 3,000 prescriptions
  4. 2,000 prescriptions Correct answer.

Explanation

Break-even volume equals fixed costs divided by the contribution margin per unit, here IDR 50,000 minus IDR 20,000, which is IDR 30,000. Dividing IDR 60,000,000 by IDR 30,000 gives 2,000 prescriptions per month.

Question 38Pharmacy economics and health financing

A new drug costs IDR 300 million per patient per year and adds 0.25 QALYs compared with the standard therapy. What is the incremental cost per QALY gained?

  1. IDR 75 million
  2. IDR 1.5 billion
  3. IDR 1.2 billion Correct answer.
  4. IDR 300 million

Explanation

The incremental cost-effectiveness ratio is the difference in cost divided by the difference in effect, so IDR 300,000,000 divided by 0.25 QALYs equals IDR 1.2 billion per QALY. Decision-makers then compare this figure with a willingness-to-pay threshold.

Question 39Pharmacy economics and health financing

In a cost-minimisation analysis, which condition must hold for the comparison to be valid?

  1. One alternative is clearly more effective than the other
  2. The alternatives have been shown to produce equivalent health outcomes Correct answer.
  3. Only direct medical costs are considered
  4. Outcomes are measured in QALYs

Explanation

Cost-minimisation analysis compares costs only, so it is legitimate only when the interventions have demonstrated equivalent efficacy and safety. If outcomes differ, a cost-effectiveness or cost-utility framework is required.

Question 40Pharmacy economics and health financing

A manufacturer launches a me-too product priced slightly below the originator, and the payer responds by placing both in the same reimbursement group with a common reference price. Which market dynamic is the payer trying to create?

  1. Elimination of patient cost-sharing
  2. Guaranteed market exclusivity for the originator
  3. Full cost recovery for all stock-keeping units
  4. Price competition among therapeutically interchangeable products Correct answer.

Explanation

Grouping interchangeable products under a common reimbursement ceiling forces manufacturers to compete on price, because patients pay any excess above the reference. This is a demand-side mechanism that uses substitution to drive down expenditure.

Question 41Pharmacy economics and health financing

Which of the following is a direct medical cost in a pharmacoeconomic study of diabetes treatment?

  1. Time spent by a family member providing care
  2. Lost productivity of a patient unable to work
  3. Cost of hospitalisation for hypoglycaemia Correct answer.
  4. Cost of the patient's transport to clinic

Explanation

Direct medical costs are resources consumed by the health care system in delivering treatment, such as hospital admissions, medicines, and laboratory tests. Hospitalisation for hypoglycaemia therefore qualifies as a direct medical cost.

Question 42Pharmacy economics and health financing

A payer introduces a higher copayment for branded antihypertensives while generics remain fully covered. What is the most likely intended effect?

  1. Increased use of generics through demand-side price sensitivity Correct answer.
  2. Higher total expenditure on branded products
  3. Elimination of the need for therapeutic review
  4. Reduced generic substitution by prescribers

Explanation

Tiered cost-sharing shifts part of the price difference onto patients, so demand moves towards the lower-cost generic option. This demand-side lever lowers payer expenditure while preserving access to a covered treatment.

Question 43Pharmacy economics and health financing

Why does adverse selection threaten the viability of a voluntary health insurance market?

  1. Premiums are set below the cost of claims by regulation
  2. Providers refuse to treat insured patients
  3. Low-risk individuals drop out, raising average claims and premiums Correct answer.
  4. Insurers are legally barred from setting premiums

Explanation

When premiums reflect average risk, healthier people find cover poor value and exit, leaving a pool with higher average claims. Premiums must then rise, which drives out still more low-risk members in a spiral that can destabilise the market.

Question 44Pharmacy economics and health financing

A pharmacy switches to a just-in-time ordering system for a high-value medicine. Which financial benefit is most directly expected?

  1. Lower average inventory holding and working capital tied up Correct answer.
  2. Increased risk of stock-outs being eliminated entirely
  3. Higher purchase price per unit from wholesalers
  4. Reduced need to monitor expiry dates

Explanation

Just-in-time ordering reduces the quantity held at any time, so average inventory value and the capital and storage costs tied up in stock fall. The trade-off is greater exposure to supply disruption and stock-out risk.

Question 45Pharmacy economics and health financing

In a budget impact analysis, which element is central that a cost-effectiveness analysis does not require?

  1. The efficacy estimate from the pivotal trial
  2. The discount rate applied to future health effects
  3. The size and composition of the eligible population over time Correct answer.
  4. Incremental cost per QALY

Explanation

Budget impact analysis estimates the total financial consequence of adopting a technology for a defined population, so it requires data on eligible patient numbers, uptake rates, and time horizon. Cost-effectiveness analysis focuses instead on efficiency per unit of health gain.

Question 46Pharmacy economics and health financing

A pharmacy manager uses ABC analysis for inventory control. Which statement correctly reflects its logic?

  1. A small share of items accounts for a large share of expenditure Correct answer.
  2. Items are classified by expiry date only
  3. Classification depends on the number of suppliers
  4. All items are ordered with equal frequency

Explanation

ABC analysis applies the Pareto principle, recognising that a minority of high-value items accounts for most of the inventory spend. These A items receive tight control and frequent review, while low-value C items are managed more loosely.

Question 47Pharmacy economics and health financing

A health technology assessment committee is deciding whether to fund a new biologic. Which criterion is an example of distributive justice rather than clinical effectiveness?

  1. The impact of funding on equity of access for disadvantaged groups Correct answer.
  2. The number needed to treat for the target population
  3. The frequency of serious adverse events
  4. The relative risk reduction observed in the trial

Explanation

Distributive justice concerns how benefits and burdens are shared across the population, including fairness of access for disadvantaged groups. Clinical effectiveness measures such as relative risk reduction and number needed to treat describe health gain, not its distribution.

Question 48Pharmacy economics and health financing

A country applies external reference pricing, setting a medicine's price at the lowest price among a basket of comparator countries. Which consequence is most likely?

  1. Generic competition is automatically eliminated
  2. The policy removes the need for national price negotiation
  3. Prices in all comparator countries rise immediately
  4. Manufacturers may delay launch in low-price countries to protect prices elsewhere Correct answer.

Explanation

When a low price in one country feeds into reference baskets elsewhere, manufacturers may postpone or avoid launching there to prevent downward pressure on prices in larger markets. This launch delay is a recognised unintended effect of external reference pricing.

Question 49Pharmacy economics and health financing

A capitation contract pays a primary care clinic a fixed amount per enrolled patient. Which provider behaviour does capitation most directly incentivise?

  1. Increasing the length of inpatient stays
  2. Referring every patient to specialist care
  3. Containing the volume of services per patient Correct answer.
  4. Delivering more services per patient to raise revenue

Explanation

Under capitation the clinic receives a fixed sum per enrollee regardless of how many services are provided, so additional services add cost without adding revenue. This creates an incentive to contain service volume, with under-provision as the main risk to be monitored.

Question 50Pharmacy economics and health financing

A drug has an incremental cost-effectiveness ratio of IDR 90 million per QALY. The willingness-to-pay threshold is IDR 150 million per QALY. What is the appropriate interpretation?

  1. The drug exceeds the threshold and should be rejected
  2. The drug is dominated by the comparator
  3. The drug is cost-effective at the stated threshold Correct answer.
  4. The ICER cannot be interpreted without budget impact data

Explanation

An intervention is judged cost-effective when its ICER falls below the willingness-to-pay threshold, and IDR 90 million is below IDR 150 million. Budget impact remains relevant for affordability but does not change the cost-effectiveness conclusion at that threshold.