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영국, 미국, 한국의 줄기세포연구에 관한 정책변동 비교 분석: Advocacy Coalition Framework 모형의 적용
배그린 ( G Reen Bae ),강민아 ( Min Ah Kang ) 한국보건행정학회 2013 보건행정학회지 Vol.23 No.4
Background: Stem cell research competition is accelerating globally since President Obama signed an executive order, repealing Bush-era policy that limited use of federal tax dollars for embryonic stem cell research. Methods: In this paper, we conducted a comparative analysis of stem cell research policy changes in three countries, including the Human Fertilisation Embryology Act (HFEA) of UK, executive order 13,505 (removing barriers to responsible scientific research involving human stem cells) of USA, and Bioethics and Safety Act of South Korea. Debates on stem cell research are based on conflicts of fundamental beliefs that exist in the supporting and opposing coalitions. We compared regional characteristics of the advocacy coalitions in three countries and presented various factors that might be related to the policy changes. Results: The UK government, parliament, and the HFEA have sought expert consultations and public opinions to establish guidelines. UK has made social consensus through continued discussion for a long time. US President`s veto power was one strongest factors influencing policy. South Korean policy was influenced by public opinion and policy brokers. Also, South Korea has not made social consensus. UK had a strong leadership and strong adjustment of coalitions but US and South Korea had not. Dr. Hwang`s scandal has had one of the greatest impacts on policy decision in South Korea. Conclusion: The power of public opinion was critical in all three countries. In particular, the influence of public opinion was noticeable in South Korea. Also it turned out that in US and South Korea, the presence of a policy broker who could pursue his or her goals was the most powerful factor among the advocacy coalition factors.
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장선미 ( Sum Mee Jang ),박찬미 ( Chan Mi Park ),최윤정 ( Yoon Jeong Choi ),배그린 ( G Reen Bae ) 한국보건경제정책학회(구 한국보건경제학회) 2010 보건경제와 정책연구 Vol.16 No.3
인구 고령화가 급속히 진행되고 만성질환이 증가함에 따라 건강보험의 약품비 지출 규모와 비중은 지속적으로 증가하고 있다. 이에 본 연구에서는 향후 의료서비스 부문별로 약품비 적정화방안을 마련하는데 필요한 정보를 제공할 목적으로 건강보험 입원약품비를 결정하는 구성요소별 변동양상과 입원약품비 증감에 미친 영향을 분석하였다. 2005~2008년의 입원약품비를 분석하기 위해 건강보험 데이터베이스를 이용했으며, 동기간동안 개설 유지된 820개 병원급 이상 의료기관의 입원서비스를 분석대상으로 선정하였다. 건강보험 입원약품비 결정요소는 의약품을 기준으로 할 때 의약품별 가격과 사용량, 동일성분내 구성비로 구분하였고, 신규 진입약은 다시 신물질 신약, 기타 신약, 신제품 등으로 구분하였다. 질병군을 기준으로 한 경우에는 입원에피소드 수, 입원에피소드당 입원일수, 입원일당 약품비, 질병군별 입원에피소드 구성비로 구분하여 입원약품비 변동에 기여한 정도를 파악하였다. 의약품 단위로 분석한 결과, 의약품 가격은 입원약품비 감소를 유도한 반면 사용량은 입원약품비를 크게 증가시킨 것으로 나타났다. 신약도입에 의한 영향력은 적었으며, 동일성분내 상대적 저가인 의약품의 사용은 약간 증가했다. 질병군을 기준으로 분석한 결과, 입원에피소드 수는 입원약품비 증가의 주요 요인으로 작용했고, 입원에피소드당 입원일수는 입원약품비가 줄어드는 방향으로 작용하였다. 한편 질병군 구성비는 입원약품비가 증가하는 방향으로 영향을 끼쳤으나 그 정도는 2%미만으로 크지 않았다. 분석결과를 종합하면, 2005~2008년의 입원약품비를 증가시킨 가장 주된 원인은 입원건수 증가로 인한 사용량 증가라 할 수 있다. The pharmaceutical expenditure of the National Health Insurance (NHI) has been steadily rising due to ageing of population and increase of chronic diseases. A rise in pharmaceutical spending has therefore stirred considerable political attention in recent years and NHI health officials are looking at ways to lower these costs. Analysis of the pharmaceutical spending data provides which sector needs to be regulated in pharmaceutical policy. In this circumstance, this study aims to analyze the change of pharmaceutical spending and to identify the major determinants of pharmaceutical spending in inpatient service. The data used in the study was extracted from the National Health Insurance (NHI) claims data. The data includes inpatient pharmaceutical spending of the 820 hospitals which were secondary and tertiary hospitals between 2005 and 2008. In the study, the drugs were categorized by the characteristics: core, new or abandon products in terms of the drug utilization. To quantify which drug components are the most influential, the components were separated into three aspects in pharmaceutical spending growth for the core drug: the changes in price, volume and generic mix. The new drug growth was further categorized into four components; new chemical ingredient drug, new drug, new product drug. Also an increasing factor of inpatient pharmaceutical spending was identified by the diseases; the number of the episode, inpatient day of the episode, and the pharmaceutical spending per day in inpatient services. The results of this study suggests that the volume effect was more attributed to increase inpatient pharmaceutical expenditure than the price effects in core drug in 1998-2002. The new drug of inpatient pharmaceutical spending growth has little effect and a relatively lower price drug was slightly increased in the same chemical entity, dose, and form. The number of the episodes in inpatient services was increased steadily and inpatient day factor was decreased in the level of the diseases. The case-mix accounted for less than 2% growth. In conclusion, the results of this study provides evidences for making political decisions that the pharmaceutical regulations in Korea need to be focused on the volume controls including more to lower the number of inpatient patients.
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