Health Policy Manag.  2018 Dec;28(4):360-368. 10.4332/KJHPA.2018.28.4.360.

The Composition of Pharmaceutical Expenditure in National Health Insurance and Implications for Reasonable Spending

Affiliations
  • 1Health Insurance Policy Research Institute, National Health Insurance Service, Wonju, Korea. hyejaelee@nhis.or.kr

Abstract

BACKGROUND
The proportion of pharmaceutical expenditure out of total health-care expenditure in South Korea is high. In 2016, 25.7% of national health insurance (NHI) spending was for pharmaceuticals. Given the increasing demands for the access to newly introduced medicines and following increase in pharmaceutical spending, the management of NHI pharmaceutical expenditure is becoming more difficult.
METHODS
This study analyzed the data claimed to NHI for pharmaceutical reimbursement from 2010 to 2016.
RESULTS
The policy implications with respect to the trends and problems in spending by drug groups were elicited. First, the proportion of off-patent drugs spending which were treated to chronic disease was much higher than anti-cancer drug spending. Second, the spending to the newly introduced high-costed medicine increased, however, current price-reduction mechanism was not sufficient to manage their expenditure efficiently.
CONCLUSION
Our system seems to need several revisions to improve the efficiency of pharmaceutical expenditure and to cope with high-costed medicines. This study suggested that the prices of off-patent drugs need to be regularly readjusted and the Price-Volume Agreement System should be operated more flexibly as well.

Keyword

Pharmaceutical expenditure; Pharmaceutical pricing; Anatomical Therapeutical Chemical Classification; Atorvastatin; Imatinib; Price-volume agreement; Risk sharing agreement
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