Investigation on Synergistic Effect between Centralized Drug Quantity Purchase Policy and Medical Insurance Reimbursement System / 中国药房

OBJECTIVE：To investigate the synergistic effect and deficiencies between centralized drug quantity purchase policy and medical insurance reimbursement system ，and to provide feasible suggestion to further improve its synergistic effect. METHODS：The literature analysis method and policy evaluation method were adopted to expounds the direct and indirect synergistic effect between the current centralized drug quantity purchase policy and medical insurance reimbursement system in China，and analyze the existing problems so as to put forward the feasible suggestions. RESULTS & CONCLUSIONS ：The centralized drug quantity purchase policy had a direct impact on the payment mode of medical insurance reimbursement system in technical level ，performance evaluation in effect level and process control in management level. The indirect synergy included ： centralized drug quantity purchase policy could promote the adjustment of drug supply security system to adapt to the reform of medical insurance payment ；it could adjust the pharmaceutical market ，and affect the reform of medical insurance reimbursement system. The disadvantages were as follows ：the varieties of selected drugs was still narrow ，and there was room for further improvement in purchasing scope and medical insurance fee reduction ；“one-size-fits-all”payment standard for unselected drug might weaken pharmaceutical companies ’enthusiasm for generic drug research and development. Therefore ，the next step is to significantly expand the variety and scope of procurement ，and appropriately liberalize the medical insurance payment restrictions for drugs with fewer varieties ；coordinate medical insurance reimbursement policies and procurement programs ，and improve the rationality and perfection of medical insurance payment ；guide the medical institutions to change the concept from “price-based medical treatment ”to“value-based medical treatment ”，take into account the interests of all parties in the market ，so as to form a comprehensive coordination adjustment mechanism of drug price and medical insurance reimbursement system.

Major routes for orphan drugs to be incorporated into the reimbursement system of UK and the enlightenment to China / 中国药科大学学报

@#In order to provide enlightening experience for the establishment of reasonable and diversified orphan drugs into the reimbursement system in China, the official websites of the National Institute for Health and Care Excellence(NICE)and the National Health Service(NHS)in the UK were inspected, collecting and summarizing the relevant documents, on the inclusion of orphan drugs into the reimbursement system. Relevant literatures were analyzed with theoretical studies on the accessibility of medicines for patients with rare diseases. In the NHS system, the inclusion of orphan drugs into the reimbursement system in the UK can be achieved mainly through seven routes, with three routes that are evaluated by NICE(MTA, STA and HST)and four are directly managed by the NHS(specialized commissioning, CDF, IFRs, CtE). Through the analysis of the inclusion of orphan drugs into the reimbursement system and the various problems in the UK, we have found some enlightening experience for the establishment of the reimbursement system for orphan drugs in China.

Forecasting the Future Reimbursement System of Korean National Health Insurance: A Contemplation Focusing on Global Budget and Neo-KDRG-Based Payment Systems

With the adoption of national health insurance in 1977, Korea has been utilizing fee-for-service payment with contract-based healthcare reimbursement system in 2000. Under the system, fee-for-service reimbursement has been accused of augmenting national healthcare expenditure by excessively increasing service volume. The researcher examined in this paper two major alternatives including diagnosis related group-based payment and global budget to contemplate the future of reimbursement system of Korean national health insurance. Various literature and preceding studies on pilot project and actual implementation of Neo-KDRG were reviewed. As a result, DRG-based payment was effective for healthcare cost control but low in administrative efficiency. Global budget may be adequate for cost control and improving the quality of healthcare and administrative efficiency. However, many healthcare providers disagree that excess care arising from fee-for-service payment alone has led to financial deterioration of national health insurance and healthcare institutions should take responsibility with global budget payment as an appropriate solution. Dissimilar payment systems may be applied to different types of institutions to reflect their unique attributes, and this process can be achieved step-by-step. Developing public sphere among the stakeholders and striving for consensus shall be kept as collateral to attain the desirable reimbursement system in the future.

Survey Results of Medical Insurance Reimbursement System for Independent Medical Laboratories in Korea / 대한진단검사의학회지

BACKGROUND: A questionnaire survey was performed to perceive the problem of the current medical insurance reimbursement system for laboratory tests referred to independent medical laboratories; then, we intended to find a way to improve the reimbursement system. METHODS: Questionnaires were distributed to 220 independent medical laboratories and 700 laboratory physicians from July through October 2005. Frequency analysis was used to analyse the replies from 109 respondents to 25 questionnaire items regarding the current medical insurance reimbursement system for referral tests, problems with the system, and suggestions for the improvement of the system. RESULTS: Among the 109 respondents to this survey, 49 (45.8%) considered the current reimbursement system to be unsatisfactory, while only 16 (15.0%) answered satisfactory. The problem was that the referral clinics-not the laboratories that performed the tests--would first receive their reimbursement for the laboratory tests from Health Insurance Review Agency (HIRA) and then give a portion of the laboratory test fees to the independent medical laboratories after the deduction of administrative fees. They (62.5% of the respondents) would prefer a separated reimbursement system by which the referral clinic-as well as the independent medical laboratory-would receive their reimbursement directly from HIRA through an Electronic Data Interchange (EDI) system. In this new system, 34% of the respondents expected the quality of the laboratory tests to be improved; however, 41.6% answered that the income of the referral clinic is expected to decrease. CONCLUSIONS: For the improvement of the medical insurance reimbursement system, the administrative fee for the referral clinic and the test fee for the independent medical laboratory should be reimbursed directly to the respective organizations. These changes could be made possible with the proper analysis of medical costs and the development of an effective EDI reimbursement system.