의원 외래환자의 약품비 변화 관련요인: 처방총액 절감 인센티브제도와 DUR 제도 시행 전후를 중심으로 = Factors associated with changes in pharmaceutical expenditures of outpatient care in clinic setting : Focusing on the incentive scheme to reduce total prescribed drug expenditure and the drug utilization review system

다국어 초록 (Multilingual Abstract)

This study was performed in order to compare a change in pharmaceutical expenditures per outpatient of clinic and to analyze factors relevant to a change in pharmaceutical expenditures of clinic before and after enforcing two 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.

참고문헌 (Reference)

1 채정미, "처방총액 절감 인센티브 시범사업의 효과분석" 건강보험심사평가원 2010

2 배은영, "약제비 증가의 기여 요인과 영향 분석" 한국보건경제정책학회 13 (13): 39-54, 2007

3 김영숙, "약제비 증가요인 분석 및 관리 방안" 국민건강보험공단 건강보험정책연구원 2009

4 최윤정, "약제비 적정화를 위한 요인 분석" 건강보험심사평가원 2007

5 보건복지부, "보도자료. 2007. 11"

6 최경업, "미국 Pharmacy Benefit Management의 개요" 1 (1): 16-20, 2009

7 김성옥, "노인 약제비 관련 연구동향" 2 (2): 74-83, 2003

8 국민건강보험공단, "내부자료"

9 감사원, "국민건강보험 약제비 관리실태 감사결과 처분요구서" 감사원 2008

10 Erwin WG, "The definition of drug utilization review: statement of issues" 50 : 596-599, 1991

11 Wertheimer AI, "Quality control and drug utilization review" 10 (10): 154-157, 1988

12 Comptroller and Auditor General, "Prescribing practices and the development of general practitioner services" Department of Health and Children 1997

13 Sturm H, "Pharmaceutical policies: effects of financial incentives for prescribers" 3 : 2007

14 OECD, "OECD Health Data"

15 Lundin D, "Moral hazard in physician prescription behavior" 19 (19): 639-662, 2000

16 Armstrong EP, "How pharmacists respond to on-line, real-time DUR alerts" 38 (38): 149-154, 1998

17 Harris CM, "Fundholders' prescribing costs: the first five years" 313 : 1531-1534, 1996

18 Walley T, "Effects of a monetary incentive on primary care prescribing in Ireland: changes in prescribing patterns in one health board 1990-1995" 9 : 591-598, 2000

19 Schiff GD, "Computerized prescribing: building the electronic infrastructure for better medication usage" 279 (279): 1024-1029, 1998

20 Walley T, "Chapter 10. Financial incentives and prescribing, In Regulating pharmaceuticals in Europe: striving for efficiency, equity and qualtiy" Open University Press 2004

21 이의경, "2단계 의약품 처방조제지원시스템시범사업 평가 연구" 건강보험심사평가원 2010