건강보험 약품비 증가요인 분석: 지수법을 활용한 기여도 분석에 대한 고찰

Abstract

Background: A rise in pharmaceutical spending has been a considerable concern for national health insurance (NHI). To analyze determinants of growth in pharmaceutical expenditure, using the price index is expected to be useful. The aims of this study are to explore which price index will be used to analyze the determinants of growth in pharmaceutical expenditure and which quantity indicator will be measured. Methods: We used the NHI data from 2010 to 2019. Pharmaceutical spending was calculated using the components of price and quantity by individual medicine. Also, the three types of index (Fisher index, Laspeyres index, and Passche index) were computed. Results: The average annual growth rate of pharmaceutical spending was 4.9% overall and 4% for continued drugs. For continued drugs, the price was a declining factor, while quantity was an increasing factor. The Laspeyres index was at the upper limit, Passche index as the lower limit, and Fisher index as the geometric average. For quantity, we considered both days of medication and volume (quantity prescribed per day × the days of medication), and the days of medication were more appropriate due to low variability. Conclusion: It is important to select an appropriate method considering the data structure, collecting time, and purpose of use. If researchers want to reduce bias towards over-stating and under-stating, it is better to use Fisher index. It will be necessary to continuously analyze factors influencing the growth of pharmaceutical spending using a price index, to make pharmaceutical policy decision-making.