• 농촌의학ㆍ지역보건
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• 제27권2호
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• pp.75-86
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• 2002

의약분업실시 전후 보건소 투약환자의 특성변화, 질병양상변화 그리고 진료내용변화를 알아보기 위해 의약분업 전인 2000년 3월과 의약분업 후인 2001년 3월 각각 한 달 동안 경상남북도에 소재한 4개 보건소(도농복합형 시보건소 2개소, 군보건소 2개소)를 의약분업 전과 후에 이용한 투약환자 5,890명(의약분업 전)과 3,496명(의약분업 후)을 대상으로 건강 보험 및 의료급여 청구서를 이용하여 투약환자의 성, 연령, 주 진단명, 의료보장종류, 내소일수, 투약일수를 조사하였다. 또한 의약품 처방의 변화를 알기 위해 급성 호홉기질환 및 근골격계 질환자에 처방한 약제 종류수, 주사제 사용률, 항생제 사용률, 고가소염제 사용률를 조사하였다. 투약환자의 질환별로는 분업 전에 비해 급성호흡기 질환자는 49.7%, 고혈압환자는 18.1%, 근골격계질환자는 70.5%, 당뇨병환자는 8.5%, 소화기계질환자는 71.2%, 만성호흡기질환자는 76.4% 감소하였으며, 요도감염질환자는 의약분업 전에 비해 66.7% 증가하였다. 의약분업 전후 평균 내소일수의 변화는, 성별로는 남녀 모두 의약분업 전 보다 후가 유의하게 감소하였고(p<0.01), 의료보장형태별도는 건강보험은 유의하게 감소하였으나(p<0.01), 의료급여는 유의한 변화가 없었다. 질환별로는 고혈압, 당뇨병, 근골격계질환에서 유의하게 감소하였다(p<0.01). 의약분업 전후 평균 투약일수는 유의하게 증가하였다(p<0.01). 질환별로는 요도감염을 제외한 다른 질환들은 유의하게 증가하였으며(p<0.01), 요도감염은 증가는 하였으나 통계적으로 유의하지는 않았다. 의약분업 전후 급성호흡기질환자에 대한 평균 처방 약제 종류수는 4.9개에서 4.7개로 유의하게 감소하였고, 주사제 사용률은 63.8%에서 7.7%로 유의하게 감소하였으며, 항생제 사용률은 33.7%에서 19.1%로 유의하게 감소하였 다(p<0.01). 의약분업 전후 근골격계질환자에 대한 평균 처방약제 종류수는 3.7개에서 3.2개로 유의하게 감소하였으며, 주사제 사용률은 64.9%에서 1.7%로 유의하게 감소하였고, 고가 소염제 사용률은 29.1%에서 39.7%로 유의하게 증가하였다(p<0.01). 이상의 결과 의약분업 후 내소환자의 평균 내소일수는 감소한 반면 평균 투약일수는 증가하였다. 의사의 처방형태의 변화로는 평균 약재 종류수는 감소하였고 주사제나 항생제 처방률은 급격히 감소하였으나, 고가 소염제의 처방률은 증가하였다.

• 보건행정학회지
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• 제11권4호
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• pp.88-108
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• 2001

Separation of prescribing and dispensing practice in Korea has changed the service pattern of the pharmacy. The prescription dispensing activities, however, are concentrated excessively on the pharmacies near hospitals or clinics. Thus this study was conducted to estimate the number of optimal dispensing cases for the community pharmacy. Forty-six pharmacies were selected using systematic stratified random sampling method, and ninety-five pharmacists were interviewed on their workload of dispensing and other activities at pharmacies. One hundred and seventy prescriptions were chosen based on the length of drug administration and drug dosage form, and the dispensing time was measured by time-watch method. Also pharmacy benefit claims data were analyzed to identify the characteristics of the pharmacies which performed more than optimal dispensing cases. According to the study results, the average work time per pharmacist per day was found to be 10hours 32minutes and the dispensing activities occupied 7hours 36minutes. It took 5.72minutes on average for each dispensing case. The optimal dispensing case was estimated as 75 cases under the condition of 10hours 32minutes work time and 6% allowance rate. Even though the pharmacies near hospitals or clinics participated dispensing services actively, only pharmacies near clinics dealt with more than optimal dispensing cases. For the pharmacies near hospitals they dealt with less than optimal cases, but drug administration period per prescription was almost 3 times longer than that of pharmacies near clinics. Thus the intensity of dispensing activities such as drug administration period is to be considered to estimate optimal dispensing cases more accurately.

• 보건행정학회지
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• 제12권3호
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• pp.23-35
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• 2002

Fiscal crisis in the medical insurance system has put the pressure upon hospitals by increasing the rate of curtailment, since the implementation of the separation of prescription and dispensing of medicine. The purpose of this study is to analyse the curtailment of mdical and drug expenditure before and after the system of separation between prescribing and dispensing and to suggest the problems about current inspection system. Data were obtained from 13 general hospitals and used for analysis of trends on medical & drug expenditure, and curtailment in 1999-2000 at three months intervals. The results were as follows; The scale of curtailment for drug expenditure has been increased on outpatient and inpatient since 2000. For the curtailed drug cost with outpatient, the ratio of curtailed drug expenditure has been increased in the case of prescription within the hospital. These results suggest that review system in social insurance were over-focused to control the cost and it might to impede the validity of review function in insurance system. Therefore, it' s needed to develope the scientific and reasonable criteria for Inspection and evaluation of durg expenditure.

• 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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• 제23권2호
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• pp.188-195
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• 2013

Background: The separation of pharmaceutical prescription and dispensing law was implemented in July 1st of 2000. This law was initiated by government without a through consensus among related stakeholders in the process of policy decision, eventually raising contention about decision making process rather than the performance of the policy. Methods: Therefore, this study tries to identify the accomplishment of the policy goals; based on the last decade's research we assessed inhibition of unnecessary prescription, drug misuse and overuse prevention, prevention of drug-related sentinel events, reducing unnecessary drug utilization, and reducing nation's medical cost. Results: Assessment results represent that government-suggested goal of the policy lacks sufficient evidence to evaluate accomplishment. Conclusion: Unlike other studies that evaluate problems regarding drug dispensing policy in the policy decision process, this study is meaningful in that it evaluated the policy goal based on the last ten years of related study results.

• 약학회지
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• 제53권2호
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• pp.45-50
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• 2009

The purpose of this study is to investigate the best way that health functional food contributes the diversification of pharmacy management at the new point after the separation of prescribing and dispensing practice. In the question of the number of prescription paper, it was more than 200 papers (18.9%), next 100 papers (11.3%). In case of daily total sales volume except prescription fee, it was more than 1,000,000won (28.3%). About the motivation using health functional food, the reason for activation of pharmacy management was 66%. The selling method was mainly by pharmacist recommendation and consumer's need. In comparison with after and before the separation of prescribing and dispensing, more than 60% of subjects answered that sales volume was decreased and no changed. Concerning the ratio of total sales volume to health functional food within 5 years, 66% of subjects expected that it will be increased positively. The type of best pharmacy to handle health functional food was community pharmacy. These results suggest that the handling of health functional food by pharmacist will greatly increase in near futures and will be very important portion for pharmacy management.

• 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.

• 한국병원경영학회지
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• 제8권3호
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• pp.118-142
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• 2003

This study is aimed at evaluating the financial structure of hospitals before and after the separation of prescription and drug dispensing policy started to be implemented in July 2000 and at making a suitable hospital managerial strategy through the verification of the factors which have effect on their profitability. This study investigated the hospitals which have passed the accredition review to be designated as a accredited training hospital each year for three years from 1999 to 2001. Those hospitals were selected from members of the Korea Hospital Association. 106 hospitals were targeted for analysis except for the hospitals whose financial statements and managerial performance were not reported faithfully. The financial indicators used in this study were stability indicators(liability to total assets, ratio of debt to fund balance, fixed ratio), liquidity indicators(current ratio, quick ratio), activity indicators(total assets turnover, fixed assets turnover), profitability indicators(net profit to total assets, net profit to net worth, operating margin), and operating expenses to patient revenues indicators(drug and supplies costs/payroll/overhead expenses). The result of this study are as follows: First, the analysis of the increase of loss-making hospitals before and after. The separation of prescription and drug dispensing policy shows that the number of loss-making hospitals increase after the separation(22.6% before the separation; 31.1% after the separation). However, there was no significant statistical difference. Second, the analysis of operating expenses to patient revenues indicators showed that the ratio of drug and supplies cost became lower in all hospitals but the ratio of payroll/overhead expenses became higher. Additionally, the factor which have the greatest effect on profitability was operating expenses to patient revenues indicators (drug and supplies costs/payroll/overhead expenses). Third, the analysis of managerial performance by four types of loss-loss, loss-profit, profit-loss and profit-profit compared the results before the separation with those after the separation revealed as follows : Reliance on liability to total assets became higher in the profit-loss type($56.2%{\rightarrow}66.4%$), lower in the loss-profit type($82.7%{\rightarrow}74.5%$). Total assets turnover became higher in the profit-profit type($1.3{\rightarrow}1.5$), but lower in the loss-profit type($0.8{\rightarrow}0.7$). Operating margin decreased to minus 5.9% from 4.3% in the profit-loss type, but increased to 7.2% from minus 7.8% in the loss-profit type. Forth, operating expenses to revenues indicators showed that the increase of payroll was the biggest in the profit-loss type($39.2%{\rightarrow}49.9%$) and that overhead cost decreased in the loss-profit type but that rather increased in other types.

• 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.

• 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.