약제비 지출의 목표관리를 위한 예산제의 국가별 비교 연구

Abstract

본 연구는 외국에서 운영되어 온 다양한 방식의 약제비 예산제 현황과 배경, 운영실적, 정책효과 등에 관한 종합적인 고찰, 비교 분석을 통해 향후 우리나라의 지속가능한 건강보험제도 운영 차원에서 약제비 총액 관리를 위한 정책 추진에 활용될 수 있는 자료를 제공하고자 함.

This study investigated the fixed budget as a pharmaceutical cost containment measure. We focused on the universal health care insurance programs of Germany, France, and Taiwan. Fixed budgets for pharmaceuticals were introduced with fixed budgets for office-based physicians fee in national health insurance systems and intended to limit the expenditures on outpatient prescription drugs. The most important reason why their governments have introduced fixed budgets for health expenditures is to contain the skyrocketing health care cost and restore financial stability in the national health insurance systems. Although healthcare providers have not been willing to agree to government's plans on fixed budget systems, social consensus and joint responsibility on health care financial stability are necessary conditions. When pharmaceutical spending exceed the budgetary target, the physician group or pharmaceutical companies could be held responsible for the cost incurred beyond the ceiling. In France, pharmaceutical companies pay back to the national health insurance authority according to their sales and sales growth in each therapeutic class. Even in fixed budget system for pharmaceuticals, drug price control and utilization management are also important in order to ensure quality use of medicines and efficient cost management.