건강보험 입원약품비 결정요인 분석

Abstract

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.