DOI QR코드

DOI QR Code

의원 외래환자의 약품비 변화 관련요인: 처방총액 절감 인센티브제도와 DUR 제도 시행 전후를 중심으로

Factors associated with changes in pharmaceutical expenditures of outpatient care in clinic setting : Focusing on the incentive scheme to reduce total prescribed drug expenditure and the drug utilization review system

  • 이명현 (건강보험심사평가원) ;
  • 정우진 (연세대학교 보건대학원) ;
  • 조은 (연세대학교 의과대학 예방의학교실) ;
  • 김노을 (연세대학교 보건정책 및 관리연구소) ;
  • 이선미 (국민건강보험공단 건강보험정책연구원)
  • Yi, Myung-Hyun (Health Insurance Review & Assessment Service) ;
  • Chung, Woojin (Graduate School of Public Health, Yonsei University) ;
  • Cho, Eun (Department of Preventive Medicine, Yonsei University College of Medicine) ;
  • Kim, Roeul (Institute of Health Services Research, Yonsei University) ;
  • Lee, Sunmi (Health Insurance Policy Research Institute, National Health Insurance Corporation)
  • 투고 : 2012.07.03
  • 심사 : 2012.10.04
  • 발행 : 2012.12.31

초록

This study was performed in order to compare a change in pharmaceutical expenditures per outpatient of clinic and to analyze factors relevant to a systems as part of evaluating policies for the incentive scheme to reduce total prescribed drug expenditure and for the drug utilization review system("DUR system" hereafter). For this, it had finally analytical subjects as 21,320 clinics nationwide without a change in location, clinics symbol and signed subject during both terms of the first half of 2010 and the first half of 2011. As a result, the odds ratio with reduction in pharmaceutical expenditures of clinic was statistically higher significantly in the shorter year number of opening clinic, in the larger number of doctors, when the classification of establishment is other, not individual, and when the signed subject is surgical division. Also, the odds ratio was significantly higher in the less patient number of clinic and in the lower ratio of patients aged over 65. Finally, the odds ratio was significantly high when a clinic had been located in DUR system demonstrative project area. Through this, a case of policy for improvement in doctor's autonomous prescription behavior like DUR system can be known to be effective for reduction in pharmaceutical expenditures. A future research on evaluation of policy for pharmaceutical expenditure management system will need to be performed in-depth analysis in consideration of diverse characteristics on the participatory entities.

키워드

참고문헌

  1. 감사원. 국민건강보험 약제비 관리실태 감사결과 처분요구서. 서울: 감사원; 2008. 5.
  2. 국민건강보험공단. 내부자료. 2012.
  3. 김성옥. 노인 약제비 관련 연구동향. 건강보험포럼 2003; 2(2): 74-83.
  4. 김영숙, 김성옥. 약제비 증가요인 분석 및 관리 방안. 서울: 국민건강보험공단 건강보험정책연구원; 2009.
  5. 배은영. 약제비 증가의 기여 요인과 영향 분석. 보건경제와 정책 연구 2007; 13(2): 39-54.
  6. 보건복지부. 보도자료. 2007. 11.
  7. 이의경, 김철환, 류시원, 허지행, 강주호, 이지현 등. 2단계 의약품 처방조제지원시스템 시범사업 평가 연구. 서울: 건강보험심사평가원; 2010.
  8. 채정미, 송현종, 김동숙, 장선미, 이승미, 이수옥 등. 처방총액 절감 인센티브 시범사업의 효과분석. 서울: 건강보험심사평가원; 2010.
  9. 최경업, 신현택. 미국 Pharmacy Benefit Management의 개요. 한국약료경영학회지 2009; 1(1): 16-20.
  10. 최윤정. 약제비 적정화를 위한 요인 분석. 서울: 건강보험심사평가원; 2007.
  11. Armstrong EP, Denemark CR. How pharmacists respond to on-line, real-time DUR alerts. J Am Pharm Assoc (Wash) 1998; 38(2): 149-154. https://doi.org/10.1016/S1086-5802(16)30314-X
  12. Comptroller and Auditor General. Prescribing practices and the development of general practitioner services. Dublin: Department of Health and Children; 1997.
  13. Erwin WG. The definition of drug utilization review: statement of issues. Clin Pharmacol Ther 1991; 50: 596-599. https://doi.org/10.1038/clpt.1991.188
  14. Harris CM, Scrivener G. Fundholders' prescribing costs: the first five years. BMJ 1996; 313: 1531-1534. https://doi.org/10.1136/bmj.313.7071.1531
  15. Lundin D. Moral hazard in physician prescription behavior. J Health Econ 2000;19(5):639-662. https://doi.org/10.1016/S0167-6296(00)00033-3
  16. OECD. OECD Health Data. 2011.
  17. Schiff GD, Rucker TD. Computerized prescribing: building the electronic infrastructure for better medication usage. JAMA 1998; 279(13): 1024-1029. https://doi.org/10.1001/jama.279.13.1024
  18. Sturm H, Austvoll-Dahlgren A, Aaserud M, Oxman AD, Ramsay C, Vernby A, et al. Pharmaceutical policies: effects of financial incentives for prescribers. Cochrance Database Syst Rev 2007; 3: CD006731.
  19. Walley T, Murphy M, Codd M, Johnston Z, Quirke T. Effects of a monetary incentive on primary care prescribing in Ireland: changes in prescribing patterns in one health board 1990-1995. Pharmacoepidemiol Drug saf 2000; 9: 591-598. https://doi.org/10.1002/pds.544
  20. Walley T, Mossialos E. Chapter 10. Financial incentives and prescribing In Mossialos E et al., Regulating pharmaceuticals in Europe: striving for efficiency, equity and qualtiy. Berkshire: Open University Press; 2004.
  21. Wertheimer AI. Quality control and drug utilization review. Pharm Weekbl Sci 1988; 10(4): 154-157. https://doi.org/10.1007/BF01959424

피인용 문헌

  1. Characteristics of Prescription Drugs for Acute Upper Respiratory Tract Infection in Outpatient Clinics vol.11, pp.3, 2017, https://doi.org/10.12811/kshsm.2017.11.3.037