• 보건행정학회지
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• 제10권2호
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• pp.41-77
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• 2000

This study aimed at the analysis, from the perspective of rationality, of policy making process in the separation of prescribing and dispensing. This study is to identify the characteristics and problems of the policy process to introduce the new durg-prescription system, and make policy recommendations. In terms of separation of prescribing and dispensing, the development of policy making process can be divided into two periods; periods before and after the inauguration of the govemment of people. In the period before the govermment of poeple, one of the major characteristics of policy decision on the new system was the poweful influence of interset groups. At that time, the ministry lacked the problem-solving ability and commitment on the policy. Consequently, during the former period, the policy making process had been driven by interest groups. Therefore, the original purpose of the policy to secure the pulic health was lost. During the latter period, there was also the strong influence of interst groups, complexity of interest, the ministry's inability of problem solving. However, in this period, it is notable that this has drawn nation-wide attention, severl civic grouos have participated in the policy making process, and that the number and voice of these groups have remarkably increased. With regards to rationality, incrementalish model is highly sutable to explain the policy making process in the former period. But in the latter period when the new drugperscripition system became a national issue and civic groups began to participte in this matter more actively, rational model is more explanatory that incrementalism to understand the process. During the latter period, the original goal of this policy was not distored by a few interest groups thanks to the rapid development of civil movement and therebly a big influence of civic groups on the policy making. For that reson, a jigh level of rationality is found in the policy-making process of the latter period. Some suggestions to achieve the rationality in the policy making process based on the results of this study are as follows; Frist, the public's participation should be enered in the policy making process. Second, the govermment should make contiuns efforts to enhance its ability of long-term planning and policy implementation, and increase rationality of policy making process. Third, balance among interset groups should take place in the process of policy making. Forth, sound, constructive, and logical activity of interest groups is necessary to express and promote their interests.

• 한국임상약학회지
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• 제21권2호
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• pp.161-169
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• 2011

The purpose of this study is to survey on the pharmacists' medication teaching service for topical steroids in regions without separation of dispensary from medical practice. The questionnaire was sent to 199 pharmacists who work inregions without separation of dispensary from medical practice via mail, e-mail or fax. 112 out of 199 pharmacists requested have answered the survey (response rate 56.28%). The questionnaire was composed of 4 categories with demographic characteristics, generally explained contents, adverse effects and precaution in pregnancy, breastfeeding and children. We analyzed the questionnaire by the 6 items with reference to the practical guidelines for medication teaching service. The medication teaching service for topical steroids in terms of generic name, physical characteristics, efficacy, usage and dosage, warning and precaution has been well provided by pharmacists in regions without separation of dispensary except for means and duration of optimal storage. The majority of pharmacists provided their patients with 4 and more kinds of items (69.64%), but the generally recommended 4 kinds of items such as generic name, efficacy, usage and dosage, warning and precaution were provided in as low as 48.22% of the respondents. These results show that the medication teaching service for topical steroids in terms of means and duration of optimal storage (45.54%) and the generally recommended 4 kinds of items have not been enough provided by pharmacists in regions without separation of dispensary. Taken together pharmacists in these regions should make a proper guideline for medication teaching service that can prevent the adverse effects of topical steroids.

• 의료법학
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• 제15권1호
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• pp.123-164
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• 2014

Under the new system of 'Separation of pharmaceutical prescription and dispensing' in Korea, which was implemented in 2000, physician could not dispense a medicine, and outpatient should have a physician's prescription filled at a drugstore. After pharmacist makes up outpatient's prescription, National Health Insurance Service(NHIS) pay for outpatient's medicine to pharmacist, except an outpatient's own medicine charge. And NHIS only pay for outpatient's prescription fee to physician and, physician doesn't derive profit from dispensing medicine in itself. Nevertheless, if physician writes out a prescription with violation of 'Criteria for the Medical Care Benefits', NHIS clawed back the payment of outpatient's prescription and medicine from the physician or the medical institution which the physician belongs to. In the past, NHIS's confiscation was in accordance with 'the National Health Care Insurance Act, Article 52, Clause 1'. But, since 2006 when the Supreme Court declared that there was no legal basis on the NHIS's confiscation of outpatient's medicine payment, NHIS had put in a claim for illegal prescriptions on the basis 'the Korean Civil law, Article 750(tort)'. So, Many medical institutions filed civil actions against NHIS. The key point of this actions was whether the issuing outpatient prescriptions with violations of Criteria for the Medical Care Benefits constitute of the law of tort. On this point, the first trial and the second trial took different position. Finally the Supreme Court acknowledged the constitution of the law of tort in 2013. In this paper, the author will review critically the decision of the Supreme Court, and consider the relativeness between the legal effect of Criteria for the Medical Care Benefits and the constitution of the issuing outpatient prescriptions with violations of Criteria for the Medical Care Benefits as the law of tort.

• 의료법학
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• 제24권3호
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• pp.3-26
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• 2023

의료인이 환자에게 직접 조제한다는 이유로 의약품공급자로부터 의약품을 취득하여 보관하고 있다가 스스로에게 투약한 경우의 약사법상 쟁점을 검토하였다. 의료인이 자가 투약 행위를 한 경우 의약품공급자나 의료인이 약사법에 따라 형사처벌될 수 있다. 그 가벌성은 약사법에서 규정한 의약품 유통 질서 훼손에 있다. 첫째, 의약품공급자가 의료인에게 의약품을 판매하는 것은 약사법 제47조 제1항 제1호 나목 위반죄의 구성요건에 해당한다. 다만, 약사법상 허용되는 직접 조제를 위해 판매한 경우 형법상 정당행위에 해당하여 위법성이 조각된다. 그러나 의약품공급자가 의료인의 자가 투약 목적을 알면서도 의약품을 판매한다면 위법성이 조각되지 않아서 형사처벌될 수 있다. 둘째, 의료인이 약사법상 직접 조제를 위하여 의약품을 취득한다고 명시적, 묵시적으로 의약품공급자를 기망하고 의약품을 취득하여 자가 투약한 경우, 기망에 의한 의약품 교부로 의료인에게 형법상 사기죄가 성립할 수 있다. 셋째, 의료인의 자가 투약 시 약사법상 조제 행위가 수반되므로 약사법 제23조 제1항 위반죄의 구성요건에 해당한다. 이때 위법성이 조각되지 않는다. 왜냐하면 의료인의 자가 투약 행위는 약사법에서 의료인에게 부여한 특별한 지위를 남용한 것으로 의약품 유통 질서를 해치고 의약분업의 취지를 훼손하는 것이어서 형법상 정당행위로 볼 수 없기 때문이다.

• 한국병원경영학회지
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• 제6권1호
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• pp.62-84
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• 2001

The purpose of the study was to compare patient's satisfaction on the pharmacy services after introducing the new system of separation of dispensing from prescribing medicines, between those filling their prescriptions from the pharmacy nearby hospitals and those from the pharmacy in their resident areas. To measure patient's satisfaction, a questionnaire survey was conducted with 354 outpatients who received prescriptions from any of the three university hospitals located in In-Cheon city. Study results showed that geographic accessibility to pharmacy was a main attribute to select pharmacy. Size of the pharmacy and availability of prescription drugs are the second major reasons for pharmacy selection for the patients from the pharmacy nearby hospital, whereas patronage is the second major reason for those from the pharmacy in resident areas. Overall satisfaction was higher among the patients from the pharmacy in resident areas than those from the pharmacy nearby hospitals, mainly due to better facilities(waiting area, public telephone, etc), kindness, cleanliness, shorter waiting time, and pharmacist's concern about patient's health. On the other hand, the patients of the pharmacy nearby hospitals showed low satisfaction because of long waiting time and the lack of pharmacist's knowledge and information about patients' health status and medication history. Patients visiting the hospital that has pharmacy-hospital cooperation system showed higher satisfaction as compared to those visiting the hospital without such system. This study provided an empirical evidence that it would be more advantageous for patients to receive pharmacy services from pharmacies located in their living areas than from pharmacies nearby hospitals. This implies that there is a strong need for adequate strategies to enhance the role of pharmacies in resident areas under the new system of separation of dispensing from prescribing medications.

• 한국병원경영학회지
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• 제7권3호
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• pp.84-101
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• 2002

This study estimated the influence of 'the separation of prescribing and dispensing roles' (SPD) policy, which implemented in July 2000, on the community pharmacies in Korea, by using data on the revenues and expenditures in the previous researches. We first assumed the rate of drug price differential was 20% with four different models which was based on various data of studies carried out in the similar period. Later, we applied different rates for the sensitivity analysis. According to the results, all community pharmacies made the net profit of 118.9 billion won (0.552 million won monthly per one pharmacy) after the SPD policy. The ratio of net profit to net sales dropped by 7.41%p from 22.19% to 14.78%. Additional sensitivity analysis indicated there were wide range of differences about whether net profit or net gain, and that extent which either existed.

• 한국병원경영학회지
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• 제8권1호
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• pp.64-80
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• 2003

The separation policy of prescription and drug dispensing which has been implemented since the 1st of July, 2000, has brought about great changes in patients flow within the healthcare delivery system. The changes in the patients flow, in turn, resulted in the change in the distribution of financial resources among the participating entities in the healthcare delivery system: pharmacies, clinics, small hospitals, general hospitals, and teaching hospitals. The purpose of this study is to shed some light in the change in the financial performance of teaching hospitals under the separation policy that has created environmental changes such as the decrease in the number of out patients visits, the increase in the capital expenditures, the rapid increase in labor costs and so on. For the purpose, this study has compared and analyzed the balance sheets, the income statements and other operational data of three teaching hospitals located in D area. The data include two periods: before(year 1999) and after(year 2001) the implementation of the separation policy. The analysis was conducted with an emphasis on the changes in the financial ratios such as liquidity, turnover ratio, performance ratio. and capitalization ratio. The results show that the financial performances of the hospitals under study were weaker than before the implementation of the separation policy, and that, while the operating expenses have increased remarkably, there was no tendency to corresponding increase in revenue. And the result of analysis of other operational indicators also show that the performance of the hospitals is getting worse. Based on the results, this study has suggested the directions of the healthcare policies. This study suggests to improve the current model of separation of prescription and drug dispensing, to grant subsidies for the training of residents in teaching hospitals, and to lower the rate of patients' out of porket payment in teaching hospitals.

• 보건행정학회지
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• 제21권2호
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• pp.179-194
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• 2011

Although there have been studies regarding the separating policy of dispensary and medical practice, little study have provided a concrete empirical evidence to what extent the policy objectives are achieved. In this paper, we try to provide empirical evidence whether the policy separating dispensary from medical practice achieved the policy objectives, which representatively are reducing the mis-use or over-use of anti-biotic prescriptions and medicines, and decreasing the government spending for the cost of pharmaceutical support. By comparing the average of the rate of change of the number of medicines prescribed, the rate of anti-biotics prescribed, and the government spending for the cost of pharmaceutical support between the areas where the separation policy was implemented and the exceptional areas, we concluded that it is difficult to conclude that the policy separating dispensary and medical practice achieved its policy objects, as it first announced to achieve in the introduction of the policy in 2000. However, the limitation of this study is that the data, that can thoroughly analyze the effect of separating policy of dispensary from medical practice, cannot be collected as expected. Hence, we could not use a parsimonious empirical model to evaluate the effect of the policy introduced in 2000. Rather we used a simple statistical method to extract enough empirical evidence fro m the data available. In the near future, we would expect to see more research that analyze the exact effect of policy separating dispensary and medical practice with concrete empirical model using more sophisticated dataset.

• 약학회지
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• 제52권6호
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• pp.507-513
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• 2008

The purpose of this study is to analyze the factors affecting financial performance of community pharmacies after the implementation of the new drug policy in Korea: separation of drug prescription and dispensing (SPD). The online survey questionnaires were sent to the active pharmacists of the total 20,633 community pharmacies in Korea and 1,147 pharmacists responded to the survey (the response rate was 5.5%). The questionnaire asked simple financial data in order to compare their financial performances before and after the policy. With the SPSS package (version 12.0), two levels of data analysis were used: 1) descriptive statistics to see the financial status of the pharmacies; and 2) multiple regression analysis to find the factors. {or A multiple regression method was used for the data analysis.} The finding illustrated that the average net benefit of the pharmacies was 4,870 thousand won in August 2006, and the major factors affecting the net benefit were the location of pharmacy (geographical proximity to medical institutions), number of prescriptions, drug management services for patients, chain pharmacy membership. The findings of this study suggest that service improvement for patients, revitalization of non-prescription drug sales, professional management will contribute to promote community based pharmacy business.

• 한국병원경영학회지
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• 제7권4호
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• pp.1-23
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• 2002

This study examined the influence of the separation of prescribing and dispensing roles(SPD) policy implemented in Korea in July 2000, especially on the change in the net profit of medical institutions. Using the data set from the Korea's National Health Insurance and the previous research, this study elicited the following main results. First, tertiary care institutions was estimated to lose about 631 billion won after the SPD policy. Second, general hospitals and hospitals gained about 557 billion and 564 billion won, respectively. Third, it is shown that clinics also gained 389-659 billion won. Finally, however, the change in net profit of medical institutions after the SPD policy largely depends on different estimation models. Moreover, it also varies from the assumptions on the price differential of a reimbursable drug which worked as cross-subsidy to insufficient physician's fee before the SPD policy. Despite such limitations as lack of data outside of the National Health Insurance's coverage, this study differs from others. This is the first research to explore the effect of the SPD policy on different types of medical institutions and to attempt to purely focus on the SPD policy. In this study, we can draw the policy implication that preparing for a policy change, the government should set up the policy evaluation system to collect the concerned data and develop the methodologies in advance to the policy implementation.