건강보험 급여 한약제제와 양방 처방의약품의 병용투여 현황

이혜재,윤난희,박소현,신승원,박민정,Lee, Hye-Jae,Yoon, Nan-He,Park, So Hyun,Shin, Seungwon,Park, Minjung 대한예방한의학회 2021 대한예방한의학회지 Vol.25 No.2

Objective : The purpose of this study is to analyze Korean patients' characteristics, who were concurrently treated with both Korean herbal medicines and Western chemical medicines using nation-wide database. Method : Using the patients sample data (HIRA-NPS 2018) provided by Health Insurance Review and Assessment Service, a group of patients who co-administered Korean herbal and Western medicines was selected, and their basic characteristics, diagnosis, and prescribed chemical medicines were analyzed. Results : Out of the 1,481,921 sample population, 17,629 patients (1.2%) were selected as a concurrent medication group. Compared to the whole sample, the concurrent medication group was composed of more women (65.8% vs. 51.1%), the more elderly people (65 or older years old) (44.5% vs. 14.6%), and the higher prevalence of chronic diseases (49.1% vs. 22.2%). The most frequent diagnosis treated with Western medicines was mental and behavioral disorders, musculoskeletal and circulatory disorders. Frequently used drugs among concurrent medication group were anti-anxiety drugs, gastric ulcer treatment drugs, and senile diseases treatment drugs. Conclusion : The evidence reported in this study is expected to provide herb-drug interaction researchers with important reference to set the priorities of research topics in the future.

미충족의료와 비급여진료비가 과부담의료비 발생에 미치는 영향

이혜재 ( Hye Jae Lee ),이태진 ( Tae Jin Lee ) 한국보건경제정책학회 2015 보건경제와 정책연구 Vol.21 No.3

Health expenditure is considered as catastrophic when a household incurs out-of-pocket health payment exceeding pre-defined thresholds of its capacity to pay. This study explored the determinants of catastrophic health expenditure using two undiscovered variables so far: unmet medical need and payment for uncovered services. Korea Health Panel was used to estimate the incidence and determinants of catastrophic health expenditure. The results showed that the incidence of catastrophic health expenditure has been increased during last five years. Contrary to hypothesis, unmet medical need was associated with increased probability of catastrophic health expenditure, and payment for uncovered services showed higher impact on catastrophic health expenditure in medical aid group than national health insurance group. Although many studies have explored catastrophic health expenditure, variables used in previous studies were limited. This study tried to investigate the impact of two new variables on catastrophic health expenditure. The results can guide future studies and regarding policies.

우리나라 가구 과부담의료비의 발생 및 재발과 관련된 요인

이혜재 ( Hye Jae Lee ),이태진 ( Tae Jin Lee ) 한국사회보장학회 2012 사회보장연구 Vol.28 No.3

Despite South Korea`s universal coverage under National Health Insurance, the financing of healthcare is still dependent heavily on out-of-pocket payment. This can lead many households to catastrophic health expenditure, which is defined as household`s spending for healthcare exceeded a certain portion of its ability to pay. Using Korea Health Panel, this study investigated the incidence of households catastrophic health expenditure and identified the factors related to incidence and recurrence of catastrophic health expenditure in South Korea, The proportion of households with catastrophic health expenditure during three periods were 13.63%, 14.80%, and 14.63%. Applying threshold of 10% of health expenditure out of household income, the panel logit model identified some factors that were related to the higher probability of catastrophic health expenditure; age, job status, and NHI status of household head, private health insurances and chronic diseases among the family members. Recurrent catastrophic health expenditure were also associated with those determinants. The positive or negative contributions of each chronic disease, Medical Aid, and private health insurance identified from this study can guide policy-makers to design better healthcare financing. Protecting people from catastrophic payments should be highly considered as a desirable objective of health policy.

일반층과 저소득층의 의료이용에 영향을 미치는 요인

이혜재 ( Hye Jae Lee ),이태진 ( Tae Jin Lee ),전보영 ( Bo Young Jeon ),정영일 ( Young Il Jung ) 한국보건경제정책학회 2009 보건경제와 정책연구 Vol.15 No.1

The purpose of this study is to find the factors that are associated with the probability and the level of the health care utilization in both the poor and the general populations. We analyzed the 2nd round of KOWEPS (Korean Welfare Panel Study) data, using `two-part model` which analyzes the probability of health care utilization experience and the level of health care utilization separately. Both the number of outpatient visit and the length of hospital stay were analyzed. According to the study results, the enabling determinants such as income and health insurance status affected the utilization of medical services in the poor, while the social-structure determinants such as job status and education level affected the general population. The number of outpatient visit predicted individual health practices better than the hospital admission. The length of hospital stay in general population was related to the opportunity cost incurred during hospital stay. In summary, there are significant limitation of the access to health care among the poor, and thus relevant intervention should be implemented to them, because they have different behavior of medical utilization from the general population.

건강보험 의약품 사용량 - 약가 연동 협상 제도의 개선안에 따른 재정 영향 시뮬레이션 분석

이혜재 ( Hye-jae Lee ) 한국보건경제정책학회 2020 보건경제와 정책연구 Vol.26 No.4

The Price-Volume Agreement (PVA) is a system that adjusts prices of pharmaceuticals when utilization quantities increase, and is expected to play a key role in managing pharmaceutical spending by National Health Insurance (NHI). However, the current system needs some improvement to meet the changing environment. In this study, various PVA revision senarios were developed using the 2015-2017 PVA results and NHI pharmaceuticals claims data, and the budget impact by each senario was analyzed. During the 3 years, total 112 medicines’ prices were reduced by 4.6% as a results of PVA. As the main factors for the revision scenarios, ‘Exclusion criteria’ to select the medicines included to PVA and ‘price reduction rate’ were developed and conjugated. As a results, total 16 scenarios were selected for the budget impact analysis. As a result of simulating the budget impact when these are applied, the maximum savings of over 100 billion won in 2017 was estimated. PVA is a system with great potential in post-market management of drug costs. Not only can the drug cost be contained, but the role of pharmaceutical spending management by government can be expanded through the efficient operation of the system. Through the scenario developed in this study, it is expected that this system can maximize its role and increase its effectiveness.

성향점수매칭으로 살펴본 의료급여 수급자와 건강보험 가입자의 본인부담 의료비 지출과 의료이용

이혜재 ( Hye-jae Lee ) 한국보건경제정책학회 2016 보건경제와 정책연구 Vol.22 No.2

Recipients of Medical Aids are in the bad socio-economic and health status, so their needs for healthcare service are high. This study used 2013 Korea Health Panel survey data and analyzed 749 Medical Aid recipients’healthcare utilization and out-of-pocket(OOP) spending. To compare them with National Health Insurance (NHI) participants, propensity score matching was used. A person with Medical Aids spent less OOP spending, while used more services. Besides the OOP payment for the hospitalization, outpatients visit and uncovered services was less, the length of days of hospitalization was longer in Medical Aids recipients than in NHI participants. This imply that people with Medical Aids receive the services with low quality of care, resulting longer therapeutic duration. This was supported with the results that Medical Aids recipients’experienced more unmet medical needs. Medical Aids has lightened the burden of healthcare cost among low-income people in South Korea, but the problem of their unmet medical need and the quality of care should be revisited. This study raises the issue of access and quality of healthcare among Medical Aids recipients, using undiscovered variables of uncovered healthcare cost and unmet medical need.

고가 의약품 건강보험 급여 현황 분석

이혜재(Hye-Jae Lee),홍지형(Jihyung Hong),배은영(Eun-Young Bae) 대한약학회 2023 약학회지 Vol.67 No.6

노인의 미충족 의료 경험의 결정요인 - 가구 유형을 중심으로

이혜재 ( Lee Hye-jae ),허순임 ( Huh Soon Im ) 한국보건경제정책학회 2017 보건경제와 정책연구 Vol.23 No.2

The objectives of this study was to investigate unmet needs for health care and to explore impact of type of households among the elderly. Types of households were classified into single person-household, couple-household, and others. Data from the Korea Health Panel Survey using nationally representative sample was analyzed. To identify factors associated with unmet needs multivariate logistic regression analyses using panel data from 2012 through 2014 were employed and subset analyses by types of household were also conducted. Elderly respondents who experienced unmet needs for health care decreased from 19.26% in 2012 to 17.92% in 2014. Those with disadvantaged socioeconomic status including education level, income, health status were more likely to experience unmet needs and type of households was significant factor associated with unmet health care needs. Subset analyses present that education level is an important factor for elderly people living separately from their children. These results suggest that financial support is important to improve unmet health care needs due to vulnerable condition for the elderly and non-financial support to understand information of health care and to visit health care facilities is also important for independent living elderly people.

우리나라 가구의 민간의료보험 과다가입 현황과 관련요인

이혜재(Hye-Jae Lee) 한국콘텐츠학회 2022 한국콘텐츠학회논문지 Vol.22 No.1

우리나라의 민간의료보험 가입자 수는 꾸준히 증가하고 있지만 그에 대한 가계부담이나 중복가입 현황에 대해서는 구체적으로 다뤄지지 않았다. 본 연구에서는 한국의료패널 2011년부터 2018년 조사자료를 사용하여 우리나라 가구의 민간의료보험 가입 현황을 살펴보았다. 또한 가구원당 민간의료보험 가입수가 3개를 초과하는 가구를 과다가입 가구로 정의하고 2018년 단면자료를 사용하여 민간의료보험 과다가입과 관련된 요인에 대해 로짓모형을 적용하여 분석하였다. 분석기간 동안 우리나라 가구의 가입 보험수는 꾸준히 증가하였으며 1인당 보험수는 2011년 1.3개에서 2018년 1.6개로 증가하였다. 1인당 보험수가 3개를 초과한 가구의 비율은 동기간 5.2%에서 10.8%로 증가하였다. 로짓분석 결과 가구주가 여성인 경우, 교육수준이 높고 고소득인 가구, 가구주 직업이 사무·서비스·판매직인 경우에 과다가입 가능성이 높아졌고, 의료급여 가구와 가구내 만성질환이 많은 가구는 과다가입 가능성이 낮아졌다. 본 연구의 결과는 향후 가구의 실손의료보험 가입의 실효성과 가계부담에 대한 심층 연구에 기초자료가 될 것으로 기대한다. Although the number of people insured by private health insurance in Korea is steadily increasing, the household burden or the status of multiple purchasing for private health insurance has not been addressed. In this study, data of the 2011-2018 Korea Health Panel Survey was used to examine the purchasing trend of Korean households’ private health insurance. Households with more than three private health insurance per household member were defined as the ‘poly-purchases’. The logit model was applied to analyze factors associated with poly-purchase of private health insurance using 2018 cross-sectional data. From 2011 to 2018, the number of insurances purchased by Korean households increased (4.0 to 4.6), the number of insurances per capita increased (1.3 to 1.6), and the proportion of the poly-purchasing households increased (5.2% to 10.8%). As a result of logit analysis, the probability of poly-purchasing was increased when the household head was a woman, with a high level of education and income, and when the job of the household head was a service or sales. Poly-purchasing was less likely when the family was subsidized with Medical Aids and suffered with more chronic diseases. The results of this study serve basic evidence for establishing policies regarding private health insurance, such as establishing the relationship between public and private insurance.

건강보험 약가제도 개편 이후 약제 등재 현황 변화

이혜재(Hye-Jae Lee) 대한약학회 2022 약학회지 Vol.66 No.2

In July 2020, the off-patent pharmaceutical price system in Korea was revised from a ‘same ingredient, same price’ principal to a ‘differentiated price’ principal, to accord with requirements met at the time of marketing authorization. This Short Report examined changes in the listing patterns of generic drugs following this policy change using the Pharmaceutical Reimbursement List and Price Table from July 2018 to October 2021. Following the revision, we observed that the number of new products listed on the table had been dropped. The monthly average number of new products was 440 prior to the revision and 84 after the revision. Two case analyses showed that this differentiated pricing system provides less motivation for generic manufactures to participate in the market after first-mover generic products have already been listed. This study reports the latest trends following this policy reform and provides baseline evidence for future policy evaluation.