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Changes in prescription pattern, pharmaceutical expenditure and quality of care after introduction of reimbursement restriction in diabetes in Korea.

Abstract：

Background:To ensure effective prescription practices and reduce diabetes-related pharmaceutical expenditures, Korea adopted a clinical practice guideline for the reimbursement system. Health care providers cannot receive reimbursement from National Health Insurance(NHI) unless it is for an appropriate prescription under the predefined clinical condition. The aim of this study was to evaluate prescription patterns in oral hypoglycemic agents, costs and effects on patient care since the introduction of the diabetes reimbursement restriction. Methods:We used claim data from 2008 to 2013, which included 26 315 diabetes patients and 9907 hospitals. An interrupted time series study design using generalized estimating equations was used to evaluate changes in patterns of single and combination therapy, brand name drug prescriptions, cost and hospital admission following the reimbursement restriction. Results:Following reimbursement restriction initiation, we found a statistically significant decrease in the average prescription rate of brand name drugs (-6.2%), whereas single therapy prescription increased (9.9%). There was also a reduction in trend change in the monthly prescription rate for combination therapy (-1.7%) and brand name drugs (-0.8%). For single therapy, the trend change in prescription rate increased after the intervention (0.8%). A reduction of trend change in pharmaceutical costs (-0.3%) was observed. However, we did not find a significant change in hospital admission for diabetes. Conclusions:Reimbursement restriction affects both pharmaceutical costs and physicians' decisions to prescribe oral hypoglycemic agents. We did not observe a significant reduction in quality of care following the intervention. Collectively, these findings indicate that reimbursement restriction has improved effective drug utilization and decreased health expenditures.

journal_name

Eur J Public Health

journal_title

European journal of public health

authors

Kim JY,Kim SJ,Nam CM,Moon KT,Park EC

doi

10.1093/eurpub/ckx168

subject

Has Abstract

pub_date

2018-04-01 00:00:00

pages

209-214

issue

eissn

1101-1262

issn

1464-360X

pii

4371600

journal_volume

pub_type

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Changes in prescription pattern, pharmaceutical expenditure and quality of care after introduction of reimbursement restriction in diabetes in Korea.