실거래가상환제의 건강보험재정에 대한 영향
Impact of the Purchasing Price Reimbursement System for Insurance Drugs upon the Health Insurer’s Financial Situation
정현선, 이의경, 김은정, 류근춘, 송양민, 김선주,
소속 상세정보
정현선 ( Jeong Hyoung-Sun )
연세대학교 보건행정학과
이의경 ( Lee Eui-Kyung )
한국보건사회연구원
김은정 ( Kim Eun-Jung )
한국보건사회연구원
류근춘 ( Ryu Gun-Chun )
한국보건사회연구원
송양민 ( Song Yang-Min )
연세대학교 보건행정학과
김선주 ( Kim Sun-Joo )
연세대학교 보건행정학과
KMID : 0387320050150030040
Abstract
The objective of this paper is to examine what impact the newly introduced Purchasing Price Reimbursement System, where insurance drugs are reimbursed at the prices as they were purchased by medical care providers under the maximum allowable cap, has upon the health insurer’’s financing situation. The impact of the Purchasing Price Reimbursement System is considered to be confined mainly to the inpatient department among three drug reimbursement fields such as inpatient department, out-patient department and pharmacy. Hypothesis was set and tested in this study for each of three components of inpatient drug reimbursement in health insurance, i.e. average price level, composition of drugs and their overall volume. Drug price level calculated in this study from 403 selected reimbursement drugs according to the Laspayres methodology revealed faster decline under the new Purchasing Price Reimbursement System than previously by 1.53% on the annual average basis. However, additional 1.4 percent financial burden in the ratio of the total inpatient reimbursement was owed by the health insurer. This was analysed to be a combined result of both 2.0-3.1 percent of reduced reimbursement due to drug price decline and 3.4-4.5 percent of additional reimbursement due to drug volume increase. These results suggest that recalling the Purchasing Price Reimbursement System would not have so much impact upon the health insurer’’s financial situation given that the current compulsory separation between doctor’’s prescribing and pharmacist’’s dispensing is irrevocable.
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