건강보험 의약품 사용량 - 약가 연동 협상 제도의 개선안에 따른 재정 영향 시뮬레이션 분석
The Simulation Analysis of Budget Impact according to the Revision scenarios of the Price-Volume Agreement of National Health Insurance Drugs
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초록
사용량-약가 연동 협상은 사용량이 증가하면 가격을 조정하는 제도로 건강보험 약품비를 관리하는 데 있어 핵심적인 역할이 기대되는 제도이다. 그러나 현재 제도는 변화하는 환경에 맞추어 몇 가지 개선이 필요하다. 본 연구에서는 2015~2017년 협상 결과와 건강보험 등재 약제의 청구액을 활용하여 다양한 개정안 시나리오를 개발하고 그에 따른 재정영향을 분석하였다. 3년간 총 112개의 약제가 사용량-약가 연동 협상에 의해 가격이 평균 4.6% 인하되었다. 협상 대상 약제를 선정함에 있어 ‘제외기준’과 협상참고가격을 산출하기 위한 산식에서의 ‘인하율’을 다양한 조건으로 변경하고 조합함으로써 총 16개의 개정안 시나리오를 개발하였고 이들이 적용되었을 경우의 재정영향을 시뮬레이션한 결과 2017년 한 해 기준 최대 1,000억원 이상의 절감액이 추정되었다. 사용량-약가 연동 협상은 약품비 사후관리에서 가능성이 큰 제도이다. 단지 약품비를 절감하는 것뿐만 아니라 제도의 유영한 운영을 통해 국가의 약품비 관리 역할을 확장할 수 있으며 재정의 불확실성을 관리할 수 있다. 본연구에서 개발한 시나리오를 통해 이 제도가 그 역할을 극대화하고 실효성을 높일 수 있을 것으로 기대한다.
Abstract
The Price-Volume Agreement (PVA) is a system that adjusts prices of pharmaceuticals when utilization quantities increase, and is expected to play a key role in managing pharmaceutical spending by National Health Insurance (NHI). However, the current system needs some improvement to meet the changing environment. In this study, various PVA revision senarios were developed using the 2015-2017 PVA results and NHI pharmaceuticals claims data, and the budget impact by each senario was analyzed. During the 3 years, total 112 medicines’ prices were reduced by 4.6% as a results of PVA. As the main factors for the revision scenarios, ‘Exclusion criteria’ to select the medicines included to PVA and ‘price reduction rate’ were developed and conjugated. As a results, total 16 scenarios were selected for the budget impact analysis. As a result of simulating the budget impact when these are applied, the maximum savings of over 100 billion won in 2017 was estimated. PVA is a system with great potential in post-market management of drug costs. Not only can the drug cost be contained, but the role of pharmaceutical spending management by government can be expanded through the efficient operation of the system. Through the scenario developed in this study, it is expected that this system can maximize its role and increase its effectiveness.
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