Browse > Article
http://dx.doi.org/10.4332/KJHPA.2018.28.4.360

The Composition of Pharmaceutical Expenditure in National Health Insurance and Implications for Reasonable Spending  

Lee, Hye-Jae (Health Insurance Policy Research Institute, National Health Insurance Service)
Publication Information
Health Policy and Management / v.28, no.4, 2018 , pp. 360-368 More about this Journal
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
Pharmaceutical expenditure; Pharmaceutical pricing; Anatomical Therapeutical Chemical Classification; Atorvastatin; Imatinib; Price-volume agreement; Risk sharing agreement;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Chun YJ, Kim CY. The factors influencing variation by local areas in antibiotics prescription rate according to the public reporting. Health Policy Manag 2012;22(3):427-450. DOI: https://doi.org/10.4332/kjhpa.2012.22.3.427.   DOI
2 Park S, Kim D, Park E, Lee S, Kim S. Study on the post management of pharmaceutical pricing. Wonju: National Health Insurance Service, Korea Institute for Health and Social Affairs; 2015.
3 World Health Organization Collaborating Centre for Drug Statistics Methodology. Guidelines for ATC classification and DDD assignment. Oslo: Collaborating Centre for Drug Statistics Methodology; 2018.
4 Farnier M, Davignon J. Current and future treatment of hyperlipidemia: the role of statins. Am J Cardiol 1998;82(4B):3J-10J. DOI: https://doi.org/10.1016/s0002-9149(98)00423-8.   DOI
5 Lee HJ, Lee TJ. Impact of price control on drug expenditure and factors associated with the drug switch among statins: analysis of HIRA-NPS data. Health Policy Manag 2013;23(2):112-123. DOI: https://doi.org/10.4332/kjhpa.2013.23.2.112.   DOI
6 Health Insurance Review and Assessment Service. 2016 Statistical index of national health insurance spending. Wonju: Health Insurance Review and Assessment Service; 2017.
7 Shibata S, Matsushita M, Saito Y, Suzuki T. Anticancer drug prescription patterns in Japan: future directions in cancer therapy. Ther Innov Regul Sci 2018;52(6):718-723. DOI: https://doi.org/10.1177/2168479017751404.   DOI
8 Bach PB, Giralt SA, Saltz LB. FDA approval of tisagenlecleucel: promise and complexities of a $475 000 cancer drug. JAMA 2017;318(19):1861-1862. DOI: https://doi.org/10.1001/jama.2017.15218.   DOI
9 Lee EK, Park E. Policy issues on drug listing of national health insurance. Public Health Welf Forum 2005;(103):103-112.
10 Bae EY. Study on the drug expenditure trend in Korea. Korean J Health Econ Policy 2007;13(2):39-54.
11 Choi YJ, Shalowitz JI. Major growths of Korean pharmaceutical expenditure. Korean J Soc Health Inf Stat 2011;36(1):15-24.
12 Lee SM, Kim NS. The development research on prescribing incentive model to reduce prescribing cost in health insurance system. Korean J Health Econ Policy 2010;16(3):63-89.
13 Kim SO, Lee JH, Shin KY. Roadmap of the management of NHI pharmaceutical expenditure: annual report of NHIS Health Insurance Policy Research Institute. Wonju: National Health Insurance Service; 2012.
14 Woo S. The issues on Korean pharmaceutical pricing policies and suggestions for reform. Welf Trends 2006;(92):52-59.
15 Sakong J, Lee K. A study on the effect of the policy for the optimization of the pharmaceutical expenditures in Korean National Health Insurance System. Korean J Health Econ Policy 2007;13(1):139-172.
16 Kwon HY, Yang BM. Fixed budget for pharmaceuticals. Korean J Health Econ Policy 2011;17(1):25-45.
17 Kim DS, Bae S, Jang S. Lessons from generic promotion policies in other countries. Korean J Health Policy Adm 2013;23(3):210-223. DOI: https://doi.org/10.4332/kjhpa.2013.23.3.210.   DOI
18 Organization for Economic Cooperation and Development. OECD health data: pharmaceutical spending [Internet]. Paris: Organization for Economic Cooperation and Development; 2018 [cited 2018 Apr 10]. Available from: https://data.oecd.org/healthres/pharmaceutical-spending.htm.
19 Health Insurance Review and Assessment Service. 2017 Statistical index of national health insurance spending. Wonju: Health Insurance Review and Assessment Service; 2018.
20 Kim SO, Choi SE. Improving price-volume arrangement system by linking expenditure target with pharmaceutical price negotiation. Korean J Health Econ Policy 2011;17(3):1-21.
21 Rhee J, Shin G. Factors associated with fixed budgets for pharmaceuticals in European Countries. Yakhak Hoeji 2013;57(3):213-218.