건강보험약가제도의 문제점과 개선방향



With the rise in the prevalence of chronic disease and aging population and increased life span, spending on medical supplies is growing fast. Despite the serious financial pressure on health insurance, which poses a threat to its sustainability, the proportion of the prescription drug cost in health insurance of Korea is much higher than those of other countries.

The biggest problem is that the high generic drug prices are encouraging the rent-seeking costs of interest groups, and that the reimbursement method of actual transaction price (ATP) and “step ladder” pricing structure have basically blocked price competition among pharmaceutical companies, which has negatively affected the financial status of health insurance. High prices of drugs also bring adverse impact on the industrial development. The easy entry to and maintenance in the pharmaceutical market led to the existence of more than 700 small pharmaceutical companies. Both large and small companies highly depend on the production of generic drugs which guarantees high return hence little efforts were made to enhance their competitiveness. Not only that, the surrounding environment makes the companies complacent with their current performance rather than to put in further efforts for improvement.

This study examines the global trend of policy goal and direction for drug prices through documents and studies at home and abroad, and then analyzes the amount of drug consumed in Korea, the proportion of generic drugs, the price comparison between brand drugs and generic drugs, and the proportion of generic drugs in the listed drugs of pharmaceutical companies. The analysis uses the prescription drug related data released from the Health Insurance Review and Assessment Service. The study also conducts an international comparison of analysis result on price and drug amount used, and analyzes the operating profit percentage of pharmaceutical companies, using data from the Korea Investors Service. Examining these, the study attempts to comprehensively identify the price level of generic drugs and its impact on the finance of health insurance and the industry.

Conclusively, the redirection for policy improvement is to reform the drug pricing policy in health insurance which hinders the price competition, and artificially maintain high drug prices. The drug pricing policy needs to be redirected to move toward the revitalization of competition in the pharmaceutical market through generic drugs. In order to encourage competition among generic drugs, the “step ladder” pricing structure should be eliminated and the reimbursement method of actual transaction price needs to be transformed into the reimbursement method of average transaction price to remove the system that restrains a price cutting competition. In addition, it is necessary to deflate the bubble in drug prices by adjusting the reimbursement prices to the lowest price level per component.

Issue Date
제1장 서 론

제2장 의약품시장의 동학(動學)과 약제비 관련 정책
 제1절 의약품시장의 동학
 제2절 약제비 관련 정책의 예
 제3절 의약품 소비구조

제3장 건강보험 약제비 관련 제도의 현황과 문제점
 제1절 약제비 규모
 제2절 우리나라의 상대적 약가 수준
  1. 약가 비교를 위한 전제
  2. 오리지널약의 상대적 가격 수준
  3. 복제약의 상대적 가격 수준
 제3절 보험약가(상한가) 결정방식
 제4절 개별 실거래가 상환제
 제5절 저가약 사용 증진과 사용량 규제
  1. 성분명 처방
  2. 사용량 규제

제4장 제약산업의 현황과 보험약가
 제1절 국내 제약산업의 현황
 제2절 품질관리
 제3절 유 통

제5장 약가제도 개선방안
 제1절 입찰제
 제2절 가격인하와 상환방식 전환
 제3절 관련 제도의 개선
  1. 생동성시험의 개선
  2. OTC 약품의 약국 외 판매 허용
  3. 의약품 유통 정보화 강화

제6장 결 론

부 록
Series Title
KDI 정책연구시리즈 2008-01
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