Effects of pharmaceutical cost containment policies on physician prescribing

Abstract

□ 의사 처방행태 및 적정성에 관한 이론적 연구 ○ 의사의 처방행태 모형 및 관련 요인, 정책의 효과 ○ 의약품 처방의 적정성 평가, 적정성 지표, 정책에서의 활용 ○ 의료서비스 공급 및 의약품 처방행위에서 비용 절감과 질 향상의 관계 □ 약제비용 절감을 위한 공급자 대상 재정적 인센티브 정책이 의약품 처방의 적정성에 미친 효과 분석 ○ 2010. 10월부터 시행중인 의원 외래처방총액 인센티브제도가 의사의 처방행태에 미친 효과 분석 ○ 공급자 대상 재정적 인센티브가 서비스 공급의 질 향상에 미친 효과에 관한 근거 생산

This study evaluated the impacts of two pharmaceutical cost containment policies-financial incentive for physicians to reduce pharmaceutical expenses and drug price cut- on physician prescribing during 2009~2012. Claims data for outpatient services in 1,625 clinics were drawn from national health insurance database between Jan. 2009 and Dec. 2012. Segmented regression analyses of interrupted times series were used to evaluate changes in pharmaceutical expenses, medical expenses, and prescribing patterns on therapeutic agents for most common diseases-gastric ulcer and gastro-oesophageal reflux disease(K25&K21), acute upper respiratory tract infections(J00~J06), acute lower respiratory tract infections(J20~J22), otitis media(H65, H66), cystitis and other disorders of urinary system(N30, N39), arthrosis(M15~M19)-in outpatient services. Monthly trend changes in pharmaceutical expenses were significantly reduced after the implementation of financial incentive program in Oct. 2010. Medical expenses and physician prescribing behaviors on therapeutic agents did not significantly change after the financial incentive program. Drug price cut in Apr. 2012 led to sudden decreases in pharmaceutical expenses in all diseases investigated. However, monthly trend changes in the pharmaceutical expenses after the price cut were significantly increased. Financial incentive on physicians was associated with continuous decrease of pharmaceutical expenses in outpatient services in clinics. Drug price cut caused instant reduction in pharmaceutical expenses, however the policy effect of price cut did not last after the sudden reduction. Further studies are needed to investigate which behaviors physicians changed to reduce their pharmaceutical expenses and whether the effects of financial incentive shown in this study continue in the longer time period.