의약품 적정 사용을 위한 처방∙조제 장려금 제도 개선 상세모형 개발 연구

Abstract

Background Drug expenses in the National Health Insurance program has continued to increase due to aging population, growing chronic diseases and appearance of high price new medicines. In response, the Health Insurance Review and Assessment Service launched "Incentive Program for Prescription and Dispensing Drug Cost Saving (hereafter Prescription and Dispensing Program)" in September 2014 to incentivize providers that make an effort to reduce drug use and lower purchasing prices. In 2014, "Drug Benefit Quality Assessment Program (hereafter VIP)" was introduced to encourage providers to voluntarily improve drug usage management for highly impactful items, such as antibiotics and injections. In an attempt to induce appropriate drug prescription, it was suggested that the two programs should be linked.

Objective This study aims to connect cost-targeting Prescription and Dispensing Program for drug cost efficiency and quality-targeting VIP program for healthcare quality improvement, in order to develop drug prescription incentive program in consideration of both cost and quality, and to test financial acceptability.

Method As a follow-up research for system improvement to induce reasonable use of drugs, such as appropriate drug use and efficient drug cost, this study aims to complement limitations of previous study by developing more detailed model and proposing the right level of incentive plan for drug consumption reduction (draft). To propose an effective improvement plan (draft), we analyzed the effect of VIP program in antibiotics prescription rate for acute upper respiratory infection. Because existing indicators had different assessment method leading to uncertain incentive reception for providers, we reviewed common assessment method using indicator values presented in advance. Lastly, the improvement model is simulated for the reviewed program to estimate financial acceptability to produce a recommendation for incentive provision plan.

Result Expansion of incentive/disincentive for antibiotics prescription rate for acute upper respiratory infection from 1% to 5% showed short-term policy effect of prescription rate decline. Recently, the prescription reduction rate has been stagnant, and poorly performing providers failed to improve results. This study proposed a drug prescription incentive model in consideration of both quality and cost by reallocating incentives to current three drug assessment indicators for outpatients within the boundary of current Prescription and Dispensing Program.

Suggestion In the previous research, injection prescription rate and more than six items prescription rate were different in nature compared to antibiotics prescription rate. Still, it failed to propose a foundation for concrete execution strategy for institution and policy change based on estimation of threshold, target, incentive budget of antibiotics prescription rate. Main achievements of this study include production of Sliding scale model, threshold, and target to complement such limitations. In addition, an appropriate incentive distribution scheme (draft) is proposed in consideration of the National Health Insurance fund and its sustainability as the source of incentive is NHI fund. Going forward, additional measures are needed to induce appropriate drug prescription practices.