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KMID : 1170320100160030063
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Korean Journal of Health Economics and Policy
2010 Volume.16 No. 3 p.63 ~ p.89
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The Development Research on a Prescribing Incentive Model to Reduce Prescribing Cost in the Health Insurance System
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Lee Seung-Mi
Kim Nam-Soon
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Abstract
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Prescribing cost of the health insurance has continuously increased every year due to rising of prescribing volume in Korea. The model development for prescribing incentive system was required following the announcement for the management measure on health insurance pharmaceutical volume in November 2007. This study was performed to develop the model of the prescribing incentive system for clinics. Foreign systems to regulate prescribing cost were reviewed through the previous researches and literatures. Prescribing patterns and factors of the increased expenditure was analyzed using outpatient claims data of clinics in the health insurance in the first half year of 2006 and 2007. The draft model of prescribing incentive system for clinics was developed by gathering opinions from relevant organizations and taking professional advises, and was applied to claims data to verify and complement the model. Outpatient Prescribing Costliness Index was developed to evaluate the level of relative costliness for prescribing cost and assign the graded percentage for incentive. The saving was calculated by subtract the true expenditure from the expected prescribing cost multiplying prescribing cost per patient in the previous year by the number of patients in the present year. Incentive to an individual clinic was designed in proportion to saving. The introduction of prescribing incentive system may induce practitioners to raise awareness of drug expenditure and may suppress an increasing rate of prescribing cost of the health insurance. By monitoring a pilot program, the government must identify potential problems and discuss how to improve the system.
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KEYWORD
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prescribing incentive system, health insurance, prescribing cost
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