Health Policy and Management (보건행정학회지)

Korean Academy of Health Policy and Management (한국보건행정학회)
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The Composition of Pharmaceutical Expenditure in National Health Insurance and Implications for Reasonable Spending

건강보험 약품비 구성 분석을 통한 지출효율화 방안 연구

  • Lee, Hye-Jae (Health Insurance Policy Research Institute, National Health Insurance Service)
  • 이혜재 (국민건강보험공단 건강보험정책연구원)
  • Received : 2018.07.31
  • Accepted : 2018.08.21
  • Published : 2018.12.31
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Abstract

Background: The proportion of pharmaceutical expenditure out of total health-care expenditure in South Korea is high. In 2016, 25.7% of national health insurance (NHI) spending was for pharmaceuticals. Given the increasing demands for the access to newly introduced medicines and following increase in pharmaceutical spending, the management of NHI pharmaceutical expenditure is becoming more difficult. Methods: This study analyzed the data claimed to NHI for pharmaceutical reimbursement from 2010 to 2016. Results: The policy implications with respect to the trends and problems in spending by drug groups were elicited. First, the proportion of off-patent drugs spending which were treated to chronic disease was much higher than anti-cancer drug spending. Second, the spending to the newly introduced high-costed medicine increased, however, current price-reduction mechanism was not sufficient to manage their expenditure efficiently. Conclusion: Our system seems to need several revisions to improve the efficiency of pharmaceutical expenditure and to cope with high-costed medicines. This study suggested that the prices of off-patent drugs need to be regularly readjusted and the Price-Volume Agreement System should be operated more flexibly as well.

Keywords

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Figure 1. Monthly pharmaceutical price and expenditure of atorvastatin 10 mg. KRW, Korean won.

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Figure 2. Monthly pharmaceutical price and expenditure of imatinib 100 mg. KRW, Korean won.

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Figure 3. Types of drug groups by price and market expansion levels and corresponding policy suggestions. NHIS, National Health Insurance Service.

Table 1. Pharmaceutical expenditures and their growth rates of the highest 30 drug groups

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Table 2. Total National Health Insurance expenditure and proportion of original drugs among atorvastatins and imatinibs in 2016

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