요양기관 종별 외래 약제비 본인부담 차등정책의 효과 분석

Abstract

Objectives: This study aims to evaluate the effectiveness of the policy on differential coinsurance for outpatient prescription drug coverage in general hospitals or advanced general hospitals among patients covered by health insurance for 52 mild diseases (Notification No. 2011-86 of the Ministry of Health and Welfare), which came into force in October 2011. Methods: The claims for health insurance coverage of outpatient medical expenditures in all general hospitals and advanced general hospitals, which were made for a year (from October 2010 to September 2011) before the policy and for two years (from October 2011 to September 2013) after the policy, were analyzed. The changes in the ratio of the number of all the claims for medical expenditures and patients to that of claims for 52 mild diseases as principal conditions and relevant patients were analyzed in terms of care institution types, gender, regions, age groups, and diseases. Results: The policy on differentiated prescription drug coverage was effective both in general hospitals and in advanced general hospitals. The number of medical claims and patients were decreased, and it was slightly more effective in advanced general hospitals. It was more effective among females than among males in terms of the number of both claims and patients. It was most effective among those in their fifties in terms of the number of claims and among those in their seventies in terms of the number of patients. It was most effective in Gangwon Province in terms of the number of claims and patients for advanced general hospitals and in Busan Metropolitan City in terms of claims and in Daejeon Metropolitan City in terms of patients for general hospitals. It was most effective on hypertension both in general hospitals and in advanced general hospitals and was more effective on chronic diseases than on acute ones. Conclusions: The policy on differential coinsurance for outpatient prescription drug coverage by care institution types was effective, as intended by the government, and the effectiveness differed by gender, age, regions, and diseases. These results are expected to be useful in enhancing the policy for preventing mild disease patients from being concentrated in large hospitals.