• 한국병원경영학회지
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• 제9권3호
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• pp.49-70
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• 2004

This study analyzes the effect of separation of dispensary from medical practice on hospital management performance. The results are as follow. The earning ratios of large size hospitals become deteriorated significantly after the separation of dispensary. The growth ratios of revenues from inpatient were unchanged, but the growth ratios of revenues from outpatient of large and middle size hospitals were decreased significantly. Hospitals can't sell the medicines to the outpatient after the separation of dispensary, but they can do to the outpatient. The labor cost ratios of small and large size hospitals are increased significantly after the separation of dispensary. There are two reasons for increase of labor cost ratios. One is the decrease of material cost ratio. The other is the increase of doctor's salary. The material cost ratios of every size hospital are decreased significantly after the separation of dispensary. Because medicines costs of outpatients are decreased. The labor cost and doctors' salary per patient of middle and large size hospitals are increased significantly after the separation of dispensary. And average treatment fees per day of inpatients of middle and large size hospitals are increased significantly after the separation of dispensary. But those of outpatients are decreased significantly. Average numbers of outpatients per bed of small and large hospitals are decreased significantly after the separation of dispensary. And average numbers of inpatients per bed of large hospitals are decreased significantly. In summary, as a consequence of separation of dispensary from medical practice, management performances of large size hospitals become deteriorated significantly.

• 한국병원경영학회지
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• 제8권4호
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• pp.121-148
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• 2003

This study is designed to evaluate the contents of the separation of prescribing and dispensing roles(SPD) policy based on the theoretical backgrounds. The results are as follows; Considering the purpose of SPD policy, 'increasing the efficiency in manpower management by separating the role of medical doctor and pharmacist and improving the quality of SPD service through specialization of function' as a policy objective is valid and very important agenda in health care. But the objectives are not working well by no keeping the detail means to actualize it. Also, some policy objectives are unclear or inappropriate and it makes the focus of that policy obscure or misleads inadequate policy alternatives. In terms of means of policy, it is evaluated to have some limits in effectiveness, efficiency, equity, rationality, technical feasibility, economic feasibility, administrative feasibility, social and time feasibility. In conclusion, it's necessary to investigate the some problem mentioned in this paper with empirical evidence. Also, it should be needed to improve the validity of policy by correcting policy objectives and means in execution of policy.

• 보건행정학회지
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• 제14권3호
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• pp.20-44
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• 2004

The National Health Insurance Expenditure has been increased rapidly since the introduction of the separation of prescription and dispensing in 2000, and this trend of rapid growth in overall spendings rate has been observed predominantly among medical practitioners. This study was conducted to investigate the growth rate and distributional changes in private medical practitioners' expenses from 1999 to 2002 and its determinants using the National Health Insurance claims data. The total increasing rate of all medical practitioners' expenditure paid by the National Health Insurance between 1999 and 2002 was $41.71\%$, which exceeding that of general hospitals by $20\%$p. But the income distribution among each practitioner was improved as the changes in Gini coefficient(from 0.40 to 0.38) and decile distribution ratio(from 0.25 to 0.29) during the same period showed. However, this improvement in distributional patterns is not enough since even in 2002 it turned out that the highest $10\%$ income group earned 33times more than the lowest $10\%$ income group did. Also, higher Gini coefficient was observed in larger cities and some department like plastic surgery, obstetrics and gynecology. The major causes of this differentials in medical practitioners' expenses were factors related to medical demand like proportion of old population, residential economic status in a given area. In addition, providers' economic incentives also played an important role in determining their income distribution. The large income differentials among physicians may imply a skewed distribution of patients and thus long waiting time, inefficient utilization of resources and potential inadequate quality of care. In this sense, unreasonable distributional gaps should be reduced, so effective measures as well as ongoing monitoring would be necessary to correct current distributional problems.

• 보건행정학회지
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• 제11권4호
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• pp.70-87
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• 2001

The purpose of this study was to identify health care providers' perceptions about the goal achievement and benefit/loss caused by the separation policy of drug prescribing and dispensing after the policy implemented on July 1, 2001. Uslng stratified sampling method based on the administration area, Ku, 315 physicians and pharmacists were sampled from the rosters of physician and pharmacist association in the city of Busan on 2001. There were 122 and 115 responses from physician and pharmacist sample, respectively. 78.3% of physicians and 50.4% of pharmacists evaluated that the goal of the policy was not achieved. Moreover, 75.3% of physicians and 40.7% of pharmacists did not support the policy. Most physicians and pharmacists considered preventing the citizens with drug abuse and misuses as the most important benefit derived from the policy. However, physicians and pharmacists concerned over raising health care cost that could be patients' burden. The most important physicians' benefit derived from the policy was free choice of all possible medicine that might result in effectiveness of medication. In physicians' the most important loss, most physicians worried about that breaking traditional patient and physician relationship might cause physicians' authority in treating diseases to be damaged. Pharmacists considered the most important policy benefit as hiked social status resulted from enforcement of profession due to the policy whereas they considered the most significant loss as expected financial problems of small pharmacies compared to that of large pharmacies or pharmacies adjacent to hospitals. In the current problems of the policy, physician and pharmacists blamed the government for inadequate preparations of the policy implementation. Physicians and pharmacists also considered citizens' mature attitudes toward the policy as a crucial success factor.

• 한국임상약학회지
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• 제21권4호
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• pp.332-338
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• 2011

This study aimed to investigate the prescription of antibiotics in clinics, and evaluate their usage appropriateness after the 2000 Korean separation of dispensary from medical practice. A retrospective study was performed on the antibiotic use for 4 years from August 2000 to July 2004 in three clinics (general, internal medicine and ear-nose-and-throat (ENT) clinics). Moreover, prescription of antibiotics for acute upper respiratory infection (AURI), concomitant drugs, duplicate antibiotics and patient adherence were assessed for 260 patients experienced AURI in a pharmacy. The prescription rates of antibiotics amongst the whole prescription decreased annually during the study period, but those in ENT clinic still constituted more than 90%. The usage of penicillins declined, but that of broad spectrum antibiotics such as amoxicillin/clavulanic acid and 1st/2nd generation cephalosporins increased. Moreover, the categories of antibiotics for the same indication were different among the clinics. For patients with AURI, the more antibiotics were prescribed as its missing days and days under its therapeutic dose increased. The drug interactions with concomitant drugs decreased annually, but the use of duplicate antibiotics was similar across the period. Potential inappropriate antibiotic use was common after the Korean policy, so the observation of pharmacists needs in addition to the patients and practitioners' attention.

• 한국병원경영학회지
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• 제7권1호
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• pp.19-40
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• 2002

The purpose of this study is to find out if there has been any change in the outpatient visit to tertiary care hospitals after the introduction of the new healthcare program that divides the roles of doctors and pharmacists and the reason for the change if there is any. Two tertiary care hospitals with the largest capacity of 1200 beds and two tertiary care hospitals with the lowest capacity of 600-700 beds were randomly selected. Data of the outpatient visits from March-May 2(xx), before the new healthcare system was adopted, were compared with the data from March-May 2001, after the new policy was adopted. Outpatient visits have decreased 5.8% after the new system. There has been a dramatic decrease, especially, in the department of OB-GYN and Pediatrics of tertiary hospitals. Decrease in re-visits is much higher than the first visits. Female patients decreased more than the male patients. Outpatient visits by economically active patients group aged 25-44 declined much. Tertiary hospitals in Seoul and Kyonggi Province, as well. Outpatient income of tertiary hospitals has dropped up to 14.7% due to the decline in outpatient visits and pharmaceutical income, and resell price system which in turn has caused the hospital financial deficits. While the new program has succeeded in lowering the use of antibiotics and injections, it has the pitfall of prescribing long days and expensive drugs. A full-fledged review of the system should be conducted for the establishment of the new system and I believe this study may be a useful references. Furthermore, more profound and overall studies on the chance in the patients use of hospitals are needed.

• 약학회지
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• 제52권6호
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• pp.471-479
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• 2008

The purpose of this study is to investigate the best way that Oriental medicine contributes for activation of pharmacy management after the separation of prescribing and dispensing practice since July 2000. In order to investigate current pharmacy conditions for handling of Oriental medicine and many problems for administering the Oriental medicine to patients, a questionnaire was written with a list of questions related to pharmacy management with Oriental medicine, and given to 58 subjects via fax or personal visit during the period of April 21 to 30, 2003. The research results was as follows; In th 58 subjects, 45 subjects (77.6%) were pharmacists with a licence for dispensing Oriental medicine. 70.7% of subjects most likely preferred to extract granule as administering type of oriental medicine. About the motivation using Oriental medicine, the reason for activation of pharmacy management was 39.7%, second, the reason for resolving the limitation of treatment over western medicine was 25.9%. Oriental medicine for patients was mainly administered by recommendation with pharmacist (65.5%). In comparison with after and before the separation of prescribing and dispensing, 51.7% of subjects answered that sale volume was decreased after the separation. Concerning the ratio of total sales volume to Oriental medicine within 5 years, 50% of subjects expected that sales volume will increase positively. About treating Oriental medcine, 34.5% of subjects thought the problem is the regulation by limiting 100 kinds of formulary. The most important factor for increasing Oriental medicine selling amount was continueous education for various information of oriental medicine in case of 44.8% of sujects. The best pharmacy to handle oriental medicine was community pharmacy (36.2%). It was expressed the reason why many pharmacists have not been treated oriental medicine because lots of time needs for dispensing prescription from clinics in these 4 years after the separation of prescribing and dispensing. These results lead to the conclusion that the Oriental medicine at pharmacy will greatly increase within 5 years and will be very important portion for pharmacy management.

• 한국병원경영학회지
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• 제7권4호
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• pp.102-122
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• 2002

It has been 2 years since the implementation of the separation policy of drug prescription and dispensing. This study analyzes the changes in community pharmacy operation after the implementation of the policy. The main purposes of the analysis are to determine whether the changes in community pharmacy operation have occurred and to evaluate that the changes are consistent with the intention of the policy, if the changes actually have occurred. For the study a survey on 961 pharmacies chosen by stratified sampling method has been performed. Of the 961 sample pharmacies, 438 pharmacies were responded resulting 45.6% response rate. The sample pharmacies are classified by the location that the pharmacy are operating: the pharmacies around large size hospitals, the pharmacies around clinics or medium to small size hospitals and the pharmacies with no hospitals or clinics around. Based on the classification, the number of pharmacies, number of prescriptions processed, the personnel structure, the changes in facility, and other operational characteristics are compared. The results showed that the pharmacies were tended to concentrate around hospitals and clinic since the implementation of the policy. The number of pharmacists per pharmacy was increased, the size of pharmacy was increased and the facilities were improved to accomodate the requirements of the policy. The work hours a pharmacist spent on dispensing drug have increased almost twice, however, there was no corresponding increase in the time spent on patient education and medication history management, indicating a problem in the provision of quality pharmaceutical services. Based on the results, suggestions to minimize the negative effects of the policy are provided.

• 한국병원경영학회지
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• 제8권2호
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• pp.93-110
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• 2003

Fiscal crisis in the medical insurance has put the pressure upon hospitals by increasing the rate of curtailment, since the implementation of the separation between prescription and dispensing of Drug. The purpose of this study is to analyze the curtailment for antibiotics, injected drug and other drugs expenditure before and after the system of separation between prescribing and dispensing. Data were gathered from 13 general hospitals and used for analysis of trends on antibiotics and injected drug expenditure, and curtailment in 2000-2001 at three months intervals. The results were as follows; The curtailment rate of antibiotics expenditure has been increased in outpatient and inpatient since 2000. The curtailed antibiotics cost and injected drug cost in outpatient under the prescription within the hospital and in inpatient increased. The ratios of curtailment versus expenditure had increased in antibiotics, injected drugs, anticancer drugs, antiulcer drugs, albumine, antiinflammatory drugs. These results suggest that claim review system in social health insurance were over-focused mainly to control the cost and it might to impede the validity of claim review function in health insurance system. Therefore, it's needed to develope the scientific and reasonable parameter & criteria for claim review of drug expenditure.

• 한국임상약학회지
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• 제12권2호
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• pp.85-90
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• 2002

The aim of this study was to examine the current turnover status of hospital pharmacists and to analyze the factors which affected the turnover of them after the separation of prescribing and dispensing practice. We surveyed 19 managers of hospital pharmacies and 154 hospital pharmacists. Results are as follows. Pharmacist manpower of hospital pharmacies was only $63.99\%$ in tertiary hospitals and $76.78\%$ in general hospitals respectively of the number of pharmacists before the separation of prescription and dispensing practice. The ratio of those who left hospital pharmacies during the period of January 2000 and October 2001 was $80.23\%$ for tertiary hospitals, and $100.84\%$ for general hospitals. Decrease in the number of pharmacists brought the increase of work load and night duty. Major factors which affected the turnover of hospital pharmacists were found as following: income gap between hospital pharmacists and community pharmacists, increasing workload especially at night and on holidays, infrequent chance for the promotion, and low chance to provide clinical pharmacy services after the separation of prescribing and dispensing practice. Adequate manpower is the basic factor for providing hospital pharmacy services and improving clinical pharmacy services. The study suggested that proper number of hospital pharmacists is to be ensured through strengthening the legal requirement for the hospital pharmacists and improving health insurance reimbursement rate for the pharmaceutical services at hospital.