지원사업
학술연구/단체지원/교육 등 연구자 활동을 지속하도록 DBpia가 지원하고 있어요.
커뮤니티
연구자들이 자신의 연구와 전문성을 널리 알리고, 새로운 협력의 기회를 만들 수 있는 네트워킹 공간이에요.
초록· 키워드
오류제보하기
In the 1990s-2000s, pharmaceutical expenditures became a socially important issue because of continuous price inflation. Our reimbursement system consists of reimbursement maximum setting and market price reimbursement. Reimbursement policy must consider balance between national health insurance finance and profits of drug companies or hospitals. Price negotiation power of government is definitely important in maintaining the proper balance.
The National Health Insurance Corporation (NHIC) is a public insurer for the public health insurance program in Korea, and The Health Insurance Review Agency (HIRA) is responsible for reviewing medical fees and evaluating whether health care services are medically necessary and delivered to beneficiaries at an appropriate level and cost.
However, they have very weak negotiation power under the present 'market price reimbursement system'. A criterion for reimbursement decisions, under this system, is average exchange price, and so, the NHIC must pay the price decided in the market as it is.
In addition, drug companies or hospitals report the NHIC how much market price of a drug is, and the reported price, that can be false, becomes, mostly, the market price for reimbursement. It is very hard for The NHIC to know the true exchange price between drug companies and hospitals.
Under the present 'market price reimbursement system', pharmaceutical expenditure of government increases fast. Our government has no direct control power of drug price, contrary to lots of developed countries, and can not fix drug price at levels deemed reasonable and affordable to the health care system. Our government can decide only reimbursement maximum.
Our reimbursement system, according to principle of economical efficiency, must be reformed for the government to use economic evaluations more positively in drug reimbursement and control drug price for reimbursement directly.
First, Drug reimbursement review committee of The Health Insurance Review Agency (HIRA) must be reorganized. Present committee members are mostly pharmacists or physicians, and they are very vulnerable to illegal rebates or illegal lobbying activities by drug companies or hospitals.
Second, Reimbursement decision must be cost-effective and consider manufacturing cost of a drug. By price comparison of drugs, government must take proper measures to reduce excessive gap of prices between drugs of the same kind.
Third, It must be obligatory on pharmaceutical companies to report manufacturing costs of drugs, and violation of this duty can be connected with sanction instruments such as revocation of patent or drug approval, or exception from drug lists for reimbursement.
Fourth, the National Health Insurance Corporation (NHIC) must find typical characteristics of past rebate cases, and if illegal symptoms are showed from companies or hospitals, The NHIC should make powerful administrative investigations, that include frequent unexpected audits or inspections.
The National Health Insurance Corporation (NHIC) is a public insurer for the public health insurance program in Korea, and The Health Insurance Review Agency (HIRA) is responsible for reviewing medical fees and evaluating whether health care services are medically necessary and delivered to beneficiaries at an appropriate level and cost.
However, they have very weak negotiation power under the present 'market price reimbursement system'. A criterion for reimbursement decisions, under this system, is average exchange price, and so, the NHIC must pay the price decided in the market as it is.
In addition, drug companies or hospitals report the NHIC how much market price of a drug is, and the reported price, that can be false, becomes, mostly, the market price for reimbursement. It is very hard for The NHIC to know the true exchange price between drug companies and hospitals.
Under the present 'market price reimbursement system', pharmaceutical expenditure of government increases fast. Our government has no direct control power of drug price, contrary to lots of developed countries, and can not fix drug price at levels deemed reasonable and affordable to the health care system. Our government can decide only reimbursement maximum.
Our reimbursement system, according to principle of economical efficiency, must be reformed for the government to use economic evaluations more positively in drug reimbursement and control drug price for reimbursement directly.
First, Drug reimbursement review committee of The Health Insurance Review Agency (HIRA) must be reorganized. Present committee members are mostly pharmacists or physicians, and they are very vulnerable to illegal rebates or illegal lobbying activities by drug companies or hospitals.
Second, Reimbursement decision must be cost-effective and consider manufacturing cost of a drug. By price comparison of drugs, government must take proper measures to reduce excessive gap of prices between drugs of the same kind.
Third, It must be obligatory on pharmaceutical companies to report manufacturing costs of drugs, and violation of this duty can be connected with sanction instruments such as revocation of patent or drug approval, or exception from drug lists for reimbursement.
Fourth, the National Health Insurance Corporation (NHIC) must find typical characteristics of past rebate cases, and if illegal symptoms are showed from companies or hospitals, The NHIC should make powerful administrative investigations, that include frequent unexpected audits or inspections.
목차
Ⅰ. 의약법상 경제성원칙과 약제비상환금액의 급격한 증가의 통제필요
Ⅱ. 약제급여상환제로서 실거래가상환제
Ⅲ. 현행 실거래가상환제의 문제점과 개혁방향
Ⅳ. 결어
참고문헌
〈Abstract〉
참고문헌 (22)
참고문헌 신청
1. [학술지(정기간행물)] - 갈원일 / 2008 / 우리나라의 약가관리제도 / 의약품정책연구 3 (2)
2. [학술지(정기간행물)] - 고영훈 / 1999 / 의약품의 가격관리제도에 대한 법적 검토 / 사회과학연구 9
3. [보고서] - 김성옥 / 2005 / 고가의약품 사용실태 및 영향요인 분석
4. [학술지(정기간행물)] - 김진현 / 2008 / 약가관리제도의 전반적인 평가 및 개선방안 / 의약품정책연구 3 (2)
5. [학술지(정기간행물)] - 보건복지가족부 / 2008 / 우리나라 보건의료 실태분석 결과 - OECD Health Data 2008 주요내용 -
2. [학술지(정기간행물)] - 고영훈 / 1999 / 의약품의 가격관리제도에 대한 법적 검토 / 사회과학연구 9
3. [보고서] - 김성옥 / 2005 / 고가의약품 사용실태 및 영향요인 분석
4. [학술지(정기간행물)] - 김진현 / 2008 / 약가관리제도의 전반적인 평가 및 개선방안 / 의약품정책연구 3 (2)
5. [학술지(정기간행물)] - 보건복지가족부 / 2008 / 우리나라 보건의료 실태분석 결과 - OECD Health Data 2008 주요내용 -
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