한국콘텐츠학회논문지 (The Journal of the Korea Contents Association)

  • 제22권6호
  • /
  • Pages.712-728
  • /
  • 2022
  • /
  • 1598-4877(pISSN)
  • /
  • 2508-6723(eISSN)
한국콘텐츠학회 (The Korea Contents Association)
권호 표지
DOI QR코드

DOI QR Code

국외 약사서비스 지불보상체계 현황 : 일본, 미국, 영국을 중심으로

Current Status of the Reimbursement for Pharmacist-provided Health Care Services in Japan, the United States, and the United Kingdom

  • 박지현 (덕성여자대학교 약학대학)
  • 투고 : 2022.05.13
  • 심사 : 2022.06.17
  • 발행 : 2022.06.28
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

세계적으로 노인인구 급증으로 병용약물이 늘어나고, 의료기술의 발달에 따라 다양한 질병 상태의 해소를 위한 약물사용이 늘어나고 있어, 약물의 효과적이고 안전한 사용을 위해 약사의 전문지식에 대한 기대 및 요구는 점차 높아지고 있다. 이에 우리나라는 지난 2009년부터 기존 4년 교육이 아닌 6년제로 약학대학의 학제를 개편하였으며, 고도화된 약료서비스의 제공을 위해 준비된 전문인력을 배출하고 있다. 그러나 현행 국민건강보험 급여체계는 여전히 전통적 약사의 역할인 조제를 중심으로 산정되어, 약사가 제공하거나 제공 가능한 서비스와, 실제로 지급되는 보상급여 간 극심한 간극이 존재하고 있다. 이에 본 연구에서는 약료서비스 지불보상제도의 국제적 동향을 비교분석하여, 현행 한국의 지불보상체계에 시사점을 주고자 하였다. 한국과 일본, 영국 및 미국의 약사서비스 지불보상정책 및 관련 문헌을 검토한 결과, 일본, 영국 및 미국의 시스템은 환자중심의 약료서비스에 대해 제도적으로 구체적이고 다양한 지불수단을 마련하여 보상하고 있으나, 한국의 약국 서비스는 상대적으로 조제관련 행위만 보상하는 정도에 그치고 있어, 국내 약료서비스의 발전을 구조적으로 저해하는 결과를 낳고 있는 것으로 나타났다. 결론적으로, 안전한 약물사용을 위한 환자중심 약료서비스의 제공을 위해서는 국내 지불보상체계가 인정하는 약료서비스의 범위를 확대하고 관련 서비스의 종류를 다양화하여 국내 약사급여제도를 개선시켜나갈 필요가 있다.

World-widely, there has never been a greater need for people to access high-quality expertise about the effective and safe use of medications. Therefore, the profession of pharmacy should meet these needs of the times, as the demographic shifts have led to a situation where older adults now outnumber children, and polypharmacy is also a commonplace. However, the reimbursement system covered by the National Health Insurance (NHI) in Korea is still limited to the traditional dispensing and compounding role of pharmacist. To provide a take-home message to Korean pharmacy reimbursement system, we aimed to review and analyze the international trends in pharmacy remuneration systems. This is a comparative study between Korea, Japan, the United Kingdom, and the United States. Comparison was conducted by reviewing each country's policy and enforcement programs, as well as the related literature. Japan, the UK and the US systems remunerate diverse patient-centered pharmaceutical care services. The Korean pharmacy service fee is, however, narrowly focused on the traditional product-oriented pharmacy services. This study discussed the future direction of improving pharmacist reimbursement systems in Korea, by expanding professional pharmacy service coverage and diversifying fee schedule.

키워드

참고문헌

  1. Y. Song, "Position and valuation of hospital pharmacy services within the fee-for-service system," Journal of Korean Society of Health-System Pharmacists, Vol.31, No.6, pp.1054-1066, 2014.
  2. W. H. Kim and E. Han, "A Review of the Efficiency of Pharmaceutical Expenditure in Korea," Public Finance Forum, Vol.290, pp.59-62, 2020. http://kiss.kstudy.com/thesis/thesis-view.asp?g=kissmeta&m=exp&enc=1A1EEE1DF2A2CA232BB7E
  3. H. O. Lee and J. O. Byeon, "Capturing the Patient-centeredness and New Communities in the Perceived Roles of Community Pharmacists," Yakhak Hoeji, Vol.64, No.5, pp.418-429, 2020. https://doi.org/10.17480/psk.2020.64.5.418
  4. I. H. Lee, N. K. Je, E. J. Kyung, J. Y. Kim, and S. Lee, "Drug utilization review from a perspective of community pharmacists in South Korea: a qualitative study," The Korean Journal of Health Economics and Policy, Vol.17, No.3, pp.127-161. 2011.
  5. G. B. Lee and H. Y. Kang, "Review of National Policies for Safe and Appropriate Use of Medications in Korea and Selected Countries," Journal of Korean academy of social & managed care pharmacy, Vol.5, No.1, pp.16-28, 2016,
  6. Y. S. Shin. H. J. Kang, D. K. Hwang, S. J. Kim, S. W. Kim, S. L. Ha, K. R. Park, J. H. Kim, E. W. Seo, Y. Ahn, J. H. Kim, H. S. Jung, H. S. Kim, J. I. Na, and S. J. Kim, Research on the finantial accountability for the 3rd reform of relative value scale, 2019.
  7. B. K. Yoo, Y. S. Lee, and R. Y. Kang, "Current status of pharmaceutical care service in community pharmacy in Korea," Yaghag-hoi-ji, Vol.62, No.1, pp.14-20, 2018. https://doi.org/10.17480/psk.2018.62.1.142018.
  8. J. Yoon, "Development of a Pharmaceutical Care Service Model for Patients with Diabetes in Ambulatory Care Settings," Korean Journal of Clinical Pharmacy, Vol.27, No.1, pp.1-8, 2017. https://doi.org/10.24304/kjcp.2017.27.1.1
  9. K. E. Kwon, M. G. Kim, M. K. Shim, and H. Sohn, "The Status and Perception on Compounding Powdered Medicine for Adult Patients in Community Pharmacies," [The Status and Perception on Compounding Powdered Medicine for Adult Patients in Community Pharmacies]. Yakhak Hoeji, Vol.63, No.4, pp.185-191, 2019. https://www.kci.go.kr/kciportal/ci/sereArticleSearch/ciSereArtiView.kci?sereArticleSearchBean.artiId=ART002500320 2019. https://doi.org/10.17480/psk.2019.63.4.185
  10. S. H. Kwon, E. H. Sohn, and H. L. Kim, "A Comparative Study on Health Insurance Fees Related to Community Pharmacists' Services in Korea and Japan," [A Comparative Study on Health Insurance Fees Related to Community Pharmacists' Services in Korea and Japan]. Yakhak Hoeji, Vol.65, No.1, pp.10-16, 2021. https://www.kci.go.kr/kciportal/ci/sereArticleSearch/ciSereArtiView.kci?sereArticleSearchBean.artiId=ART002690957 https://doi.org/10.17480/psk.2021.65.1.10
  11. Y. J. Kim, "NHS Hospital Pharmacist Training Programme in UK," Korean Journal of Clinical Pharmacy, Vol.25, No.4, pp.209-215, 2015.
  12. H. L. Kim, M. H. Kim and H. Park, "Comparative Study on Reimbursement Fees Related to Hospital Pharmacists'Services in Korea and Japan," Journal of Korean Society of Health-System Pharmacists, Vol.38, No.1, pp.75-92, 2021. https://doi.org/10.32429/JKSHP.2021.38.1.006
  13. H. L. Kim, Y. H. Jo, J. H. Lee, E. Y. Jeon, J. Y. Lee, and E. M. Kim, "Research on the Relative Value of Pharmaceutical Care Services Performed by Hospital Pharmacists," [Research on the Relative Value of Pharmaceutical Care Services Performed by Hospital Pharmacists]. Journal of Korean Society of Health-System Pharmacists, Vol.38, No.2, pp.155-170, 2021. https://www.kci.go.kr/kciportal/ci/sereArticleSearch/ciSereArtiView.kci?sereArticleSearchBean.artiId=ART002719368 2021. https://doi.org/10.32429/JKSHP.2021.38.2.001
  14. Y. D. Park, [Contribution] Need to increase pharmacy service fee by reevaluation, Dailypharm, 2020. http://www.dailypharm.com/Users/News/NewsView.html?ID=270328
  15. S. Y. Suha, et al., "Analysis of Work Activities and Proportion of Time Performed by Hospital Pharmacists," Journal of Korean Society of Health-System Pharmacists, Vol.37. No.2, pp.126-150, 2020. https://doi.org/10.32429/JKSHP.2020.37.2.001
  16. C. Wohlin, "Guidelines for snowballing in systematic literature studies and a replication in software engineering," Proceedings of the 18th international conference on evaluation and assessment in software engineering, 2014.
  17. S. Y. Nam, "The Study on Japanese Health Care Insurance and Medical Service Reimbursement System," Korean Medical Association, pp.1-346, 2010.
  18. S. Lee, "Pharmacy retail system under the reformed pharmacy law," Korea Legislation Research Institute, 2009.
  19. M. Yearm, "The effect of the improvement of the sales regulation of general medicine and political proposals," Journal of channel and retailing, Vol.15, No.5, pp.237-255, 2010.
  20. H. Eom, "The Revision of Medical Fee Schedule in Japan, 2020," HIRA Research, Vol.14, No.3, pp.66-76, 2020.
  21. J. Kim, "A Study on the Health Insurance System in Japan : Comparison with Korea's Health Insurance," Ewha Women's University The Graduate School of Converging Clinical & Public Health, Master's Degree Thesis, 2019.
  22. Y. H. Lee, J. N. Nam, and E. Cho, "The Factors Related to the Intention of Pharmacists for Participating in the Designated Pharmacy Program," Korean Journal of Community Pharmacy, Vol.3, No.2, pp.93-101, 2017.
  23. B. Kim, "From Beveridge Welfare State to Cameron Government: A Case Study of Britain on the Role and Strategies of Think Tanks in Welfare State Paradigm Changes," Korean Journal of Social Welfare, Vol.67, No.2, pp.259-284. 2015. https://doi.org/10.20970/kasw.2015.67.2.011
  24. J. Cylus, E. Richardson, L. Findley, M. Longley, C. O'Neill, D. Steel, and W. H. Organization, "United Kingdom: health system review," 2015.
  25. W. Baqir, D. Miller, and G. Richardson, "A brief history of pharmacist prescribing in the UK," European Journal of Hospital Pharmacy: Science and Practice, Vol.19, No.5, pp.487-488, 2012. https://doi.org/10.1136/ejhpharm-2012-000189
  26. C. Cheong and S. E. Choi, "Global trends in remuneration systems for community pharmacy services and implications to Korea," The Korean Journal of Health Economics and Policy, Vol.19, No.4, pp.129-151, 2013.
  27. PIP, "DRUG TARIFF PRICE INFORMATION,"
  28. P. S. N. Committee, Professional Fees (Drug Tariff Part IIIA). 2022. https://psnc.org.uk/dispensing-supply/endorsement/fees-allowances/
  29. D. K. Lee, "UK, Pharmacist prescriber status to be expanded," The Yakup, 2000. https://www.yakup.com/news/index.html?mode=view&nid=4945
  30. K. Park, N. Kim, J. H. Kim, and S. Jang, "2019 The current health insurance systems and reformation trend in major countries," National Health Insurance Services, 8(United Kingdom). https://nl.go.kr/NL/contents/N20103000000.do?schM=contView&schOpt1=CA0000000031&schOpt2=CA0000000374&schOpt3=01&schIdSub=CO202011101402426521 2019, Services, N. H. "Primary care services," Retrieved from https://www.england.nhs.uk/get-involved/get-involved/how/primarycare/ 2022.
  31. E. Birbeck, "Clinical pharmacists supporting inpatient diabetes patients," Diabetes & Primary Care, Vol.21, No.5, 2019.
  32. M. Ross, Pharmacist Tops Forbes' List of Best Health Care Jobs in 2015, Pharmacy Times, 2014. https://www.pharmacytimes.com/view/pharmacist-tops-em-forbes-em-list-of-best-health-care-jobs-in-2015.
  33. M. Matalavage, Navigating the Complexities of Pharmacy Reimbursement: Will We Ever Reach Transparency?, Pharmacy Times, 2016. https://www.pharmacytimes.com/view/navigating-the-complexities-of-pharmacy-reimbursement-will-we-ever-reach-transparency
  34. S. M. Sarah Shoemaker-Hunt, Olivia Bacon, Jacqueline Gillis, Jason Brinkley, Marci Schalk, and Lauren Olsho, Cost of Dispensing Study, A. Associates, 2020.
  35. G. Sachdev, M. A. Kliethermes, V. Vernon, S. Leal, and G. Crabtree, "Current status of prescriptive authority by pharmacists in the United States," Journal of the American College of Clinical Pharmacy, Vol.3, No.4, pp.807-817, 2020. https://doi.org/10.1002/jac5.1245
  36. H. C. H. Karen Whalen, Reimbursement for pharmacist services, In Medication Therapy Management: A Comprehensive Approach (2e ed.). https://accesspharmacy.mhmedical.com/book.aspx?bookID=2319 2018.
  37. N. Agrawal, "Understanding Medicare Part B incident to billing," Bulletin of the American College of Surgeons, Vol.101, No.8, pp.51-52, 2016.
  38. A. M. Association, "CPT (Current Procedural Terminology)," Retrieved from https://www.ama-assn.org/amaone/cpt-current-proceduralterminology 2021.
  39. A. Cernasev, M. Aruru, S. Clark, K. Patel, N. Dipietro Mager, V. Subramaniam, andH. A. Truong, "Empowering Public Health Pharmacy Practice-Moving from Collaborative Practice Agreements to Provider Status in the U.S." Pharmacy, Vol.9, No.1, p.57, 2021. https://doi.org/10.3390/pharmacy90100572021.
  40. C. Eickhoff, N. Griese-Mammen, U. Meller, A. Said, and M. Schulz, "Primary healthcare policy and vision for community pharmacy and pharmacists in Germany," Pharm Pract (Granada), Vol.19, No.1, 2248, 2021. https://doi.org/10.18549/PharmPract.2021.1.2248
  41. S. H. Kim, M. H. Kim, E. H. Son, and H. Kim, "A Review on Service Fees of Pharmacists : Focused on the Medication Therapy Management Service in the United States," Journal of Korean Academy of Managed Care Pharmacy, Vol.7, No.2, pp.102-110, 2019.
  42. D. Weitzman, Provider Status for Pharmacists: It's About Time, Pharmacy Times, 2020. https://www.pharmacytimes.com/view/provider-status-for-pharmacists-its-about-time
  43. D. Oh, "A Study on the Sensitivity of Conversion Factor According to Change of Base Year," [A Study on the Sensitivity of Conversion Factor According to Change of Base Year]. Journal of the Korea Academy Industrial Cooperation Society, Vol.21, No.4, pp.201-209. 2020. https://www.kci.go.kr/kciportal/ci/sereArticleSearch/ciSereArtiView.kci?sereArticleSearchBean.artiId=ART002580068 2020.
  44. D. Chung, 2022 Dispensing Fee to rise by 3.6%, Korea Pharmaceutical Association News, 2021.
  45. J, H, Lee, H. S. Shin, and H. T. Shin, "Quality Evaluation of Medication Counseling in Korean Community Pharmacies," Korean Journal of Clinical Pharmacy, Vol.19, No.2, pp.131-145, 2009.
  46. Y. S. Shin, H. W Shin, D. K. Hwang, P. K. Yoon, and J. Na, "A research on the improvement of differential payment policy in primary care (dispensing)," In: Health Insurance Review and Assessment Service, 2009.