DOI QR코드

DOI QR Code

우리나라 건강보험의 위험분담제도가 재정 및 환자접근성에 미친 영향

An Overview of the Risk Sharing Management in Korean National Health Insurance, Focused on the Effect of the Patient Access and Insurance Finance

  • 이종혁 (호서대학교 생명보건과학대학 제약공학전공) ;
  • 방준석 (숙명여자대학교 임상약학대학원)
  • Lee, Jong Hyuk (Department of Pharmaceutical Engineering, College of Life and Health Science, Hoseo University) ;
  • Bang, Joon Seok (Graduate School of Clinical Pharmacy, Sookmyung Women's University)
  • 투고 : 2018.04.18
  • 심사 : 2018.06.18
  • 발행 : 2018.06.29

초록

Objective: This study examined the Risk Sharing Agreement (RSA) on pharmaceutical pricing system in Korean national health insurance. Through RSA, the insurer was able to maintain the principles in the price listing process while managing the budget effectively and improving patient access to new drugs. Despite these positive effects, there are still issues raised by some stakeholders, such as lack of transparency in the listing process and doubts about its effectiveness. Therefore, we investigated the impacts of RSA on national health insurance financing and patient access to analyze the effects of RSA. Methods: The impact of RSA was investigated by analyzing the health insurance claims data for 2014~2016. The degree of improvement in patient access was determined by the decreased amount of patients' payment. Results: Results showed that the financial impact of RSA was not significant and patients' access to the new drug greatly improved. Conclusion: These results show that RSA is a good system for improving patient access to new drugs without additional expense on insurance.

키워드

참고문헌

  1. Health Insurance Review and Assessment Service (HIRA). Improvement of patients' access of drugs for 4 major diseases. 2016.
  2. Ministry of Health and Welfare (MOHW). Health insurance coverage for high-priced drugs such as targeted cancer drugs is expanded. Available from http://www.mohw.go.kr/react/al/sal0301vw.jsp?PAR_MENU_ID=04&MENU_ID=0403&BOARD_ID=140&BOARD_FLAG=00&CONT_SEQ=290962&page=1. Accessed July 28, 2017.
  3. Health Insurance Review and Assessment Service (HIRA). Detailed evaluation criteria for drugs subject to negotiation include new drugs, etc. Available from http://www.hira.or.kr. Accessed July 28, 2017.
  4. Health Insurance Review and Assessment Service (HIRA). Regulation for evaluation criteria and procedures for reimbursement eligibility of drugs. 2016.
  5. Klemp M, Fronsdal KB, Facey K, et al. What principles should govern the use of managed entry agreements? Int J Technol Assess Health Care 2011;27(1):77-83. https://doi.org/10.1017/S0266462310001297
  6. Spoors J. Patient access schemes in the new NHS. Brit J Healthc Manag 2012;18(8):412-8. https://doi.org/10.12968/bjhc.2012.18.8.412
  7. Vitry A, Roughead E. Managed entry agreements for pharmaceuticals in Australia. Health Policy 2014;117(3):345-52. https://doi.org/10.1016/j.healthpol.2014.05.005
  8. Garattini L, Casadei G. Risk sharing agreements: What lessons from Italy? Int J Technol Assess 2011;27(2):169-72. https://doi.org/10.1017/S0266462311000079
  9. Cheong C, Son KB, Bae EY. Risk Sharing Agreements on Pharmaceuticals: Lessons from Foreign Countries' Experience. J Health Tech Assess 2013;1(1):51-60.
  10. Managed entry agreements for pharmaceuticals: the European experience. Available from http://eprints.lse.ac.uk/50513/. Accessed July 28, 2017.
  11. List of technologies with approved Patient Access Schemes. Available from https://www.nice.org.uk/About/What-we-do/Patient-access-schemes-liaison-unit/. Accessed July 28, 2017.
  12. Health Insurance Review and Assessment Service (HIRA), Seoul National University. A study on the post-listed management of the drug that listed by risk sharing management. 2016.
  13. Lee YS, Bae SJ, Lee BR, et al. Review of Risk Sharing Arrangements in Some Developed Countries: Focusing on Type of Contracts and Management System. J Health Tech Assess 2017;5(1):13-21.

피인용 문헌

  1. Use of budget savings from patent expiration of cancer drugs to improve affordability and accessibility vol.21, pp.1, 2021, https://doi.org/10.1186/s12913-021-06130-y