• Health Policy and Management
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• v.21 no.1
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• pp.132-157
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• 2011

The purpose of this article is to examine the cause of policy non-compliance in the case of pharmaceutical rebates from the perspective of rational choice institutionalism. In Korea, there have been rebates practices between pharmaceutical companies and hospitals since the introduction of the Actual Remuneration System for insured medicine in 1999. The government has chosen the policy means of punishment to eliminate pharmaceutical rebates but the illegal practices are still widespread. Institution in rational choice institutionalism usually reflects the incentives and preferences of actors, and the Actual Remuneration System has resulted in a the lack of procedures to ensure savings on drug expenditures. Pharmaceutical rebates are the product of the institutions which reflect their incentives: the Actual Remuneration System, the current pricing policy for generic drugs, the drug distribution system, and so on. In the end, the problem of the rebates is the consequence of policy non-compliance as actors' rational choice because their incentives lead to opportunistic behaviors. We should therefore understand the incentive structure of policy stakeholders, which is derived from the view of new institutionalism; also, the newly designed Korean drug pricing policy reform must be compatible with the incentive structure.

• Health Policy and Management
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• v.22 no.4
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• pp.561-578
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• 2012

This study was performed in order to compare a change in pharmaceutical expenditures per outpatient of clinic and to analyze factors relevant to a systems as part of evaluating policies for the incentive scheme to reduce total prescribed drug expenditure and for the drug utilization review system("DUR system" hereafter). For this, it had finally analytical subjects as 21,320 clinics nationwide without a change in location, clinics symbol and signed subject during both terms of the first half of 2010 and the first half of 2011. As a result, the odds ratio with reduction in pharmaceutical expenditures of clinic was statistically higher significantly in the shorter year number of opening clinic, in the larger number of doctors, when the classification of establishment is other, not individual, and when the signed subject is surgical division. Also, the odds ratio was significantly higher in the less patient number of clinic and in the lower ratio of patients aged over 65. Finally, the odds ratio was significantly high when a clinic had been located in DUR system demonstrative project area. Through this, a case of policy for improvement in doctor's autonomous prescription behavior like DUR system can be known to be effective for reduction in pharmaceutical expenditures. A future research on evaluation of policy for pharmaceutical expenditure management system will need to be performed in-depth analysis in consideration of diverse characteristics on the participatory entities.

• Korean Journal of Clinical Pharmacy
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• v.24 no.3
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• pp.183-192
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• 2014

Purpose: This study was aimed to identify the status of utilization of healthcare services and self-care behaviors, knowledge level and influencing choice factors of non-prescription drugs (OTCs) on consumers since sales of OTCs at the outside of pharmacy in Korea, and to confirm the changes in perception of consumers for OTCs policy through check of perception level for current OTCs policy. Methods: Data was collected from April 2014 to May 2014 from questionnaires by 418 adults who are in university located in Seoul or live in Seoul Metropolitan area but not health science major and healthcare providers. Results: The female gender was 56.6% and University students were 73.9%. The ratio by age was as follows: below 25 (60.9%), 26-30 (18.2%), 30-40s (14.9%) and 50-60s (6.0%). The knowledge level of OTCs for use of medicine, dose and side effects was generally low and especially they knew little how to deal with side effects after taking OTCs on sale at the outside of pharmacy, even though over one year has passed since the policy. The proportion of those who thought the current OTCs policy has problems regarding safety issues since the policy was very high and it was also high that the study group thought there are problems with the current way to sale OTCs and educate employees. Conclusion: After selling OTCs at the outside of pharmacy, the consumers still lacked knowledge of OTCs and did not get correct information properly. Especially, they had little information about the way to deal with side effects after taking OTCs. Public policy should be based on the health of the people and the public health is a national health priority. When all these things are taken into consideration, the government has to strengthen the OTCs policy and provide a safer environment with the accurate drug information for people than developing OTCs policy in the future.

• Korea Journal of Hospital Management
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• v.7 no.4
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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.

• Health Policy and Management
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• v.9 no.2
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• pp.118-138
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• 1999

This study presents the variations on drug utilization for outpatients' URI, gastritis. and hypertension by the type of hospital- tertiary hospital. general hospital. hospital. clinic. It investigated drug expenses. daily drug expenses. days of medication. the highest price of the drugs used. and the number of the different drugs used for each disease and type of hospital. This study also performed analysis to see how much the variations of variables related to drug use affect the variations of drug expenses. The dependent variable was drug expenses and the independent variables were days of medication. the average price of the drugs used. and the number of the different drugs used. Analysis of the drug utilization was performed on NFMI(National Federation of Medical Insurance) 1994 medical expense claim data. Patients with secondary diseases were excluded. In this study. 379 patients with URI, 386 patients with gastritis. 1.257 patients with hypertension were included. It was founded that there were large variation on drug utilization between the types of hospital for same diseases. Days of medication were longest in tertiary hospitals and shortest in hospitals or clinics. Clinics showed the lowest daily drug expenses in all of the diseases investigated. Daily drug expenses were highest in general hospitals or hospitals. which also tended to use drugs of higher price than other types of hospital. General hospitals and hospitals had larger variations in daily drug expenses and the highest price of drugs. It suggested that drug might be utilized overly in general hospitals and hospitals and some other factors might influence on drug utilization in these hospitals. It was found that the variations of drug expenses were affected by the variations of drug price and days of medication rather than the number of the different drugs. Then the strategy to reduce the variations of drug utilization and to improve the quality of drug utilization should focus on the drug price and days of medication. Further study is needed to assess the quality as well as the variation of drug utilization and to show the factors which affect them.

• Korea Journal of Hospital Management
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• v.8 no.1
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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.

• Health Policy and Management
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• v.7 no.2
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• pp.89-108
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• 1997

The purpose of this study is to investigate drug information sources which influence physician's prescriptions, and to compare the differences of drugh information sources between private practitioners and hospital physicians. In addition, the ultimate goal of this study is to provide better quality of drug information for both groups of physicians through the professional drug information system. 264 physicians, including general practitioners and all types of specialists who were working in hospitals and private clinics in Taejon and Chungnam area, participated in this study which was conducted by mail. The results are summarized as follows ; 1. Both physician groups received drug informations mainly from medical journals, but there were differences in secondary sources of drug information. Namely, hospital physicians got drug information from annual meetings and textbooks, and private practitioners got it from detail men and colleagues. 2. Drug effect was the first consideration for drug selection in both physician groups. But, in the 2nd consideration, private practitioners concerned about the price, insurance and rebates, but hospital physicians were not. 3. Only 9.2% of the private practitioners satisfied with the sufficiency of drug information, whereas 22.0% of hospital physicians satisfied with it. The most insufficient area of information was drug interaction in both groups and 91.9% of the physicians suggested that a professional drug information system should be introduced. 4. Both physician groups had contacted with detail men frequently. However, it was rare for them to contact with a pharmacist. This phenomenon was more severe in the case of private practitioners. 5. Neither physician groups knew very much about drug informatio centers. However, they would be willig to participate if a professional drug information system were established. Also, they indicated that the information most required was drug interaction.

• Proceedings of the PSK Conference
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• 2005.11a
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• pp.114-115
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• 2005

• Health Policy and Management
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• v.12 no.3
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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.

• Health Policy and Management
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• v.24 no.2
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• pp.120-127
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• 2014

Background: Since December 2010, online computerized prospective drug utilization review (pDUR) has been implemented in Korea. pDUR involves the review of each prescription before the medication is dispensed to the individual patient. The pDUR is performed electronically by Health Insurance Review & Assessment Service (HIRA), which is a Korean governmental agency, and then HIRA provides medical institutions and pharmacies with information that can be helpful to them in preventing potential drug problems such as drug/drug interactions or ingredient duplication. The aim of this study was to assess the impact of the Korean pDUR implementation on the proportion of drug-drug interactions (DDIs) using claims data from HIRA. Methods: A before-after comparison of the prevalence of DDIs between prescription was conducted, using HIRA administrative claims data of medical institution from January 2010 to December 2011. The analysis unit was the prescription issued and pairs before and after. The main outcome measures were the proportion of DDIs within- (control group) or between- physician encounters. To examine the difference, a paired t-test was applied. Results: We found that DDIs proportion between prescription decreased significantly (t=3.04, p=0.0026) after the implementation of pDUR, whereas there is no significant reduction within prescription (t=1.15, p=0.2518). With respect to the prevalence of DDIs between drug groups, the most dramatic reduction was occurred between 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors and anti-fungal agents. Conclusion: It seems effective that giving a direct feedback to prescribers by a prospective DUR. Further research is needed to assess the impact of DUR to final outcomes such as hospitalization.