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Abate TW, Gedamu H, Ayalew E, Genanew A, Ergetie T, Tesfa G. A systematic review and meta-analysis of the Ethiopian cohort of adult hypertensive people's adherence to healthy behaviors. Heliyon 2022; 8:e11555. [DOI: 10.1016/j.heliyon.2022.e11555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 06/25/2022] [Accepted: 11/02/2022] [Indexed: 11/11/2022] Open
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2
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Yeung VW. Temporal expectancy induced by the mere possession of a placebo analgesic affects placebo analgesia: preliminary findings from a randomized controlled trial. Sci Rep 2022; 12. [PMID: 35082351 PMCID: PMC8792021 DOI: 10.1038/s41598-022-05537-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 01/10/2022] [Indexed: 11/21/2022] Open
Abstract
Research on placebo analgesia usually shows that people experienced a reduction in pain after using a placebo analgesic. An emerging line of research argues that, under some circumstances, merely possessing (but not using) a placebo analgesic could induce placebo analgesia. The current study investigates how temporary expectation of pain reduction associated with different forms of possessing a placebo analgesic affects pain outcomes. Healthy participants (n = 90) were presented with a vial of olive oil (placebo), described as a blended essential oil that blocks pain sensations upon nasal inhalation, and were asked to anticipate the benefits of such analgesic oil to the self (such as anticipating the analgesic oil to reduce their pain). Participants were randomized into one of three different possession conditions: physical-possession condition (participants possessed a tangible placebo analgesic oil, inducing an expectation to acquire analgesic benefit early upon the experience of pain), psychological-possession condition (participants possessed a coupon, which can be redeemed for a placebo analgesic oil, inducing an expectation to acquire analgesic benefit later upon the experience of pain), or no-possession condition. Participants did a cold pressor test (CPT) to experience experimentally-induced pain on their non-dominant hand. Their objective physical pain responses (pain-threshold and pain-tolerance), and subjective psychological pain perception (pain intensity, severity, quality, and unpleasantness) were measured. Results revealed that participants in the physical-possession condition reported greater pain-threshold, F(2, 85) = 6.65, p = 0.002, and longer pain-tolerance, F(2, 85) = 7.19, p = 0.001 than participants in the psychological-possession and no-possession conditions. No significant group difference was found in subjective pain perception. The results of this study can advance knowledge about pain mechanisms and novel pain management.
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Rachamin Y, Meier R, Valeri F, Rosemann T, Muheim L. Physician-dispensing as a determinant of clinical and process measurements in patients at increased cardiovascular risk: A cross-sectional study in Swiss general practice. Health Policy 2021; 125:1305-1310. [PMID: 34392960 DOI: 10.1016/j.healthpol.2021.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 07/14/2021] [Accepted: 07/30/2021] [Indexed: 12/17/2022]
Abstract
AIMS In some healthcare systems, physicians are allowed to dispense drugs; in others, drug-dispensing is restricted to pharmacists. Whether physician-dispensing affects patient health is unknown. Thus, we aimed to investigate associations between physician-dispensing and clinical and process measurements in patients with selected long-term conditions indicating increased cardiovascular risk. METHODS Retrospective cross-sectional study in 2018 based on data from electronic medical records of 22405 patients (73.6% physician-dispensing) in Switzerland with medications for diabetes mellitus, arterial hypertension, or lipid-related disorders. We used multilevel regression models to determine the associations between physician-dispensing and clinical measurements (glycated hemoglobin [HbA1c], systolic blood pressure [sBP], low-density lipoprotein cholesterol [LDL-C]) or process measurements (number of annual clinical measurements, consultations, and drug prescriptions). RESULTS Median (interquartile range) HbA1c value was 6.8% (6.3-7.5) both for the physician-dispensing and pharmacist-dispensing group, sBP was 137 (126-150) and 136 mmHg (126-149), and LDL-C was 2.3 (1.8-3.0) and 2.5 mmol/L (1.9-3.2). After adjustments, the physician-dispensing group had 4% lower LDL-C levels (p = 0.041), 12% more frequent HbA1c measurements (p = 0001), 16% higher annual consultation rates (p < 0.05 for all conditions), and equal number of different drugs, compared to the pharmacist-dispensing group. CONCLUSIONS We found no relevant differences in selected clinical measurements between physician- and pharmacist-dispensing, and mixed results in process measurements. Our results do not indicate that one drug-dispensing channel is superior to the other.
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Affiliation(s)
- Yael Rachamin
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Pestalozzistrasse 24, 8091 Zurich, Switzerland.
| | - Rahel Meier
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Pestalozzistrasse 24, 8091 Zurich, Switzerland
| | - Fabio Valeri
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Pestalozzistrasse 24, 8091 Zurich, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Pestalozzistrasse 24, 8091 Zurich, Switzerland
| | - Leander Muheim
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Pestalozzistrasse 24, 8091 Zurich, Switzerland
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Chen WH, Lee PC, Chiang SC, Chang YL, Chen TJ, Chou LF, Hwang SJ. Pharmacist Workforce at Primary Care Clinics: A Nationwide Survey in Taiwan. Healthcare (Basel) 2021; 9:healthcare9070863. [PMID: 34356241 PMCID: PMC8306307 DOI: 10.3390/healthcare9070863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/04/2021] [Accepted: 07/06/2021] [Indexed: 11/23/2022] Open
Abstract
Although dispensing is usually separated from prescribing in healthcare service delivery worldwide, primary care clinics in some countries can hire pharmacists to offer in-house dispensing or point-of-care dispensing for patients’ convenience. This study aimed to provide a general overview of pharmacists working at primary care clinics in Taiwan. Special attention was paid to clarifying the relationship by location, scale, and specialty of clinics. The data source was the Government’s open database in Taiwan. In our study, a total of 8688 pharmacists were hired in 6020 (52.1%) 11,546 clinics. The result revealed significant differences in the number of pharmacists at different specialty clinics among levels of urbanization. Group practices did not have a higher probability of hiring pharmacists than solo practices. There was a higher prevalence of pharmacists practicing in clinics of non surgery-related specialties than in surgery-related specialties. Although the strict separation policy of dispensing and prescribing has been implemented for 2 decades in Taiwan, most primary care clinics seem to circumvent the regulation by hiring pharmacists to maintain dominant roles in dispensing drugs and retaining the financial benefits from drugs. More in-depth analyses are required to study the impact on pharmacies and the quality of pharmaceutical care.
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Affiliation(s)
- Wei-Ho Chen
- Department of Medical Education, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 11217, Taiwan;
| | - Pei-Chen Lee
- Department of Pharmacy, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 11217, Taiwan; (P.-C.L.); (Y.-L.C.)
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei 10617, Taiwan
| | - Shu-Chiung Chiang
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Taipei 11217, Taiwan;
| | - Yuh-Lih Chang
- Department of Pharmacy, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 11217, Taiwan; (P.-C.L.); (Y.-L.C.)
| | - Tzeng-Ji Chen
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Taipei 11217, Taiwan;
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 11217, Taiwan;
- Big Data Center, Department of Medical Research, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 11217, Taiwan
- Correspondence: ; Tel.: +886-2-2875-7458; Fax: +886-2-2873-7901
| | - Li-Fang Chou
- Department of Public Finance, National Chengchi University, Taipei 116, Taiwan;
| | - Shinn-Jang Hwang
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 11217, Taiwan;
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5
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Wang X, Li F, Wang X, Zhang X, Liu C, Wang D, Wang H, Chen Y. Effects of different mark-up drug policies on drug-related expenditures in tertiary public hospitals: an interrupted time series study in Shanghai, China, 2015-2018. Biosci Trends 2020; 14:16-22. [PMID: 32092747 DOI: 10.5582/bst.2019.01350] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Irrational use of drugs remains a major challenge especially in developing countries, which contributed to a heavy pharmaceutical expenditure burden. Price regulation has been taken to curb the growth of pharmaceutical expenditures in many countries. This study aimed to investigate the impact of different mark-up drug policies on drug-related expenditures in tertiary public hospitals in Shanghai, China. Data were drawn from the audited financial statement in 24 tertiary public hospitals in Shanghai from January 2015 to December 2018. Drug-related revenue data and per capita cost data pre- and post-intervention were included. Interrupted time series design was applied to assess the actual effects of Fixed Percent Mark-up Drug (FPM) policy and Zero Mark-up Drug (ZMD) policy respectively. Results showed that ZMD policy achieved better intervention effects on declining drug-related expenditures than FPM policy. Apart from a declining trend in drug proportion (coefficient = -0.0017, p = 0.031), no other significant changes were found during FPM implementation. However, ZMD policy was associated with a level decline in per capita outpatient drug cost (coefficient = -12.21, p = 0.025) and a trend decline in per capita inpatient drug cost (coefficient = -25.12, p < 0.001), as well as a level decrease (coefficient = -0.0256, p = 0.001) and a downward tendency (coefficient = -0.0018, p < 0.001) in drug proportion. ZMD policy was effective in regulating drug-related expenditures, while FPM policy was difficult to achieve expected results due to the existence of profit space. Further regulation should be strengthened in the future, especially on drug revenue and per capita drug cost.
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Affiliation(s)
- Xianji Wang
- Key Lab of Health Technology Assessment, National Health Commission, School of Public Health, Fudan University, Shanghai, China
| | - Fen Li
- Shanghai Health Development Research Center, Shanghai, China
| | - Xuemei Wang
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xinping Zhang
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chenxi Liu
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Dan Wang
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Haiyin Wang
- Shanghai Health Development Research Center, Shanghai, China
| | - Yingyao Chen
- Key Lab of Health Technology Assessment, National Health Commission, School of Public Health, Fudan University, Shanghai, China
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6
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Kang SH, Kim SH, Cho JH, Yoon CH, Hwang SS, Lee HY, Youn TJ, Chae IH, Kim CH. Prevalence, Awareness, Treatment, and Control of Hypertension in Korea. Sci Rep 2019; 9:10970. [PMID: 31358791 PMCID: PMC6662850 DOI: 10.1038/s41598-019-46965-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 06/27/2019] [Indexed: 12/20/2022] Open
Abstract
The purpose of the present study was to describe the temporal trends in prevalence and management status of hypertension in Korea between 1998 and 2015. Data of adults who were aged 30 years or older were extracted from the Korea National Health and Nutrition Examination Survey, a nationwide representative population-based survey. Hypertension was prevalent in 30.5% of Korean adults. The age and sex standardized prevalence showed little change between 1998 and 2015. The elderly population and men showed higher prevalence. The rates of awareness, treatment, and control showed substantial improvements among hypertensive subjects between 1998 and the time period of 2007‒2009 (awareness, from 23.5 to 66.3%; treatment, from 20.4 to 60.3%; and control, from 4.9 to 42.1%), after which the numbers reached a plateau and no significant changes were observed subsequently (67.3%, 63.6%, and 46.2%, respectively, between 2013 and 2015). The management status remained poor especially among the young population and in men. In conclusion, the hypertension prevalence remained stable at approximately 30% in Korea between 1998 and 2015. While awareness, treatment, and control of hypertension improved remarkably, the young population and particularly men showed a suboptimal management status.
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Affiliation(s)
- Si-Hyuck Kang
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Korea.,Department of Internal Medicine, Seoul National University, Seoul, Korea
| | - Sun-Hwa Kim
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Korea
| | - Jun Hwan Cho
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Korea.,Department of Internal Medicine, Seoul National University, Seoul, Korea
| | - Chang-Hwan Yoon
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Korea.,Department of Internal Medicine, Seoul National University, Seoul, Korea
| | - Seung-Sik Hwang
- Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Hae-Young Lee
- Department of Internal Medicine, Seoul National University, Seoul, Korea.,Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Tae-Jin Youn
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Korea.,Department of Internal Medicine, Seoul National University, Seoul, Korea
| | - In-Ho Chae
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Korea.,Department of Internal Medicine, Seoul National University, Seoul, Korea
| | - Cheol-Ho Kim
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Korea. .,Department of Internal Medicine, Seoul National University, Seoul, Korea.
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Loo JSE, Lo EMY, Mai CW, Gan PW, Lee E, Tiong JJL. Separation of prescribing and dispensing in Malaysia: public perception of pharmacists’ roles and agreement towards a separation policy. J Pharm Pract Res 2019. [DOI: 10.1002/jppr.1542] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Jason S. E. Loo
- School of Pharmacy Faculty of Medical and Health Sciences Taylor's University Selangor Malaysia
| | - Eva M. Y. Lo
- Faculty of Pharmacy MAHSA University Selangor Malaysia
| | - Chun Wai Mai
- School of Pharmacy International Medical University Kuala Lumpur Malaysia
| | - Pou Wee Gan
- School of Pharmacy International Medical University Kuala Lumpur Malaysia
| | - E‐Lyn Lee
- School of Pharmacy International Medical University Kuala Lumpur Malaysia
| | - John Jeh Lung Tiong
- School of Pharmacy Faculty of Medical and Health Sciences Taylor's University Selangor Malaysia
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Kang SO, Kim SJ, Park S, Jang SI, Park EC. Do cost containment policies save money and influence physicians' prescribing behavior? Lessons from South Korea's drug policy for diabetes medication. Int J Qual Health Care 2019; 31:96-102. [PMID: 29788203 DOI: 10.1093/intqhc/mzy114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 04/08/2018] [Accepted: 04/30/2018] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE We evaluate the effects of drug price reduction policy on pharmaceutical expenditure and prescription patterns in diabetes medication. DESIGN An interrupted time series study design using generalized estimating equations. SETTING This study used National Health Insurance claim data from 2010 to 2013. PARTICIPANTS A total of 68 127 diabetes patients and 12 465 hospitals. INTERVENTION(S) The drug price reduction policy. MAIN OUTCOME MEASURES The primary outcome is pharmaceutical expenditure and prescription rate. To evaluate changes in prescription rate, we measured prescription rates such a brand-name drug and drug price reduction rate. RESULTS Although the drug price reduction policy associated with decreased pharmaceutical expenditure (-13.22%, P < 0.0001), the trend (-0.01%, P = 0.9201) did not change significantly compared with the pre-intervention period. In addition, the trends in the monthly prescription rate of brand-name drugs decreased (-0.14%, P = 0.0091), while the immediate change was an increase (5.72%, P < 0.0001). Regardless of the drug reduction rate, the prescription rate after the introduction of the drug price reduction policy decreased compared with the pre-intervention period, and this decline was significant for reduction rates of 0% (-2.74%, P < 0.0001) and 10% (-0.13%, P = 0.0018). CONCLUSIONS Our results provide evidence of the effects of the drug price reduction policy on pharmaceutical expenditure and prescription patterns. This policy did not affect the prescribing behavior of healthcare providers and did not increase the use of drugs not subject to this policy. Although this study did not observe changes in the cost of pharmaceuticals after the introduction of the drug price reduction policy, further research is needed on the long-term changes in such costs.
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Affiliation(s)
- Shin-On Kang
- Department of Value Demonstration & Access, Shire Pharmaceuticals Korea, Seoul, Republic of Korea
| | - Seung Ju Kim
- Department of nursing, College of Nursing, Eulji University, Seongnam, Republic of Korea.,Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Sohee Park
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea.,Department of Biostatistics, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
| | - Sung-In Jang
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea.,Department of Preventive Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea.,Department of Preventive Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
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9
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Greiner B, Zhang L, Tang C. Separation of prescription and treatment in health care markets: A laboratory experiment. Health Econ 2017; 26 Suppl 3:21-35. [PMID: 29285866 DOI: 10.1002/hec.3575] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/26/2017] [Accepted: 06/29/2017] [Indexed: 06/07/2023]
Abstract
Health care is a credence good, and its market is plagued by asymmetric information. In this paper, we use a laboratory experiment to test the performance of a potential remedy discussed in the applied literature, the separation of prescription and treatment activities. We observe a significant amount of overtreatment (and a smaller nonpredicted amount of undertreatment) in our baseline environment. Requiring a different than the treating physician to provide diagnosis and prescription for free is an effective way to reduce overtreatment in our laboratory setting. This effect, however, is partially offset by an increased frequency of undertreatment. Allowing prescription and treatment physicians to independently set prices for their services reduces efficiency due to coordination failures: In sum, prices are often higher than expected benefit of patients, who in turn do not attend to the physician. Also contrary to theory, bargaining power does not play a significant role for the distribution of profits between physicians.
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Affiliation(s)
- Ben Greiner
- Wirtschaftsuniversität Wien, Institute for Markets and Strategy, Vienna, Austria
- University of New South Wales, School of Economics, Sydney, Australia
| | - Le Zhang
- Macquarie Graduate School of Management, Macquarie University, Sydney, NSW, Australia
| | - Chengxiang Tang
- School of Public Administration, Guangzhou University, Guangzhou, Guangdong, China
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10
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Lee SM, Lee SO, Kim DS. Physicians’ and pharmacists’ perceptions on real-time drug utilization review system: a nationwide survey. Int J Qual Health Care 2017; 29:634-641. [DOI: 10.1093/intqhc/mzx085] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 07/03/2017] [Indexed: 11/14/2022] Open
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Abstract
Background In 2012, a new pharmaceutical policy was introduced in Korea. According to the new policy, off-patent brand-name drugs (original drugs) and generic drugs must be priced the same. Methods This study aims to investigate the perception and attitude of Korean physicians towards generic drugs before and after the policy reform. Surveys were conducted with registered doctors at the Health Insurance Review Agency (HIRA) twice, in 2011 and 2013, by means of email and HIRA online survey systems. Results In the 2011 survey, 82% knew about the bioequivalent (BE) guideline, whereas only 25.7% trusted BE testing results. More than half preferred original drugs to generic drugs because of clinical experience and generic drugs confidence limits. 64.2% pointed out that the Korean generic drugs prices are more expensive than in other counties. In the 2013 survey, 73% preferred original drugs to generic drugs because of believed difference in drug effectiveness. After the pricing policy reform, 35.5% stated that they didn’t change their prescribing pattern, whereas 29.7% stated that they began prescribing generic drugs. Conclusions The Korean government has revised and strengthen the guideline on BE test to improve the quality and confidence of generic drugs. Although generic drugs prescription was increased slightly more than the 2011 survey, 2013 survey showed that around 70% of respondents still preferred original drugs.
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Affiliation(s)
- Mikyung Ryu
- Pharmaceutical Benefits, Management division, Health Insurance Review & Assessment Service, 304 Hyoryeong-ro, Seocho-gu, Seoul, 06720, South Korea
| | - Juyoung Kim
- Pharmaceutical Benefits, Management division, Health Insurance Review & Assessment Service, 304 Hyoryeong-ro, Seocho-gu, Seoul, 06720, South Korea.
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12
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Díaz-Portillo SP, Reyes-Morales H, Cuadra-Hernández SM, Idrovo ÁJ, Nigenda G, Dreser A. [Working conditions in outpatient clinics adjacent to private pharmacies in Mexico City: perspective of physicians]. Gac Sanit 2017; 31:459-465. [PMID: 28473208 DOI: 10.1016/j.gaceta.2016.10.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 10/21/2016] [Accepted: 10/24/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To analyse the working conditions of physicians in outpatient clinics adjacent to pharmacies (CAFs) and their organizational elements from their own perspective. METHODS We carried out an exploratory qualitative study. Semi-structured interviews were conducted with 32 CAF physicians in Mexico City. A directed content analysis technique was used based on previously built and emerging codes which were related to the experience of the subjects in their work. RESULTS Respondents perceive that work in CAFs does not meet professional expectations due to low pay, informality in the recruitment process and the absence of minimum labour guarantees. This prevents them from enjoying the benefits associated with formal employment, and sustains their desire to work in CAF only temporarily. They believe that economic incentives related to number of consultations, procedures and sales attained by the pharmacy allow them to increase their income without influencing their prescriptive behaviour. They express that the monitoring systems and pressure exerted on CAFs seek to affect their autonomy, pushing them to enhance the sales of medicines in the pharmacy. CONCLUSIONS Physicians working in CAFs face a difficult employment situation. The managerial elements used to induce prescription and enhance pharmacy sales create a work environment that generates challenges for regulation and underlines the need to monitor the services provided at these clinics and the possible risk for users.
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Affiliation(s)
- Sandra P Díaz-Portillo
- Centro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | | | | | - Álvaro J Idrovo
- Departamento de Salud Pública, Escuela de Medicina, Universidad Industrial de Santander, Bucaramanga, Santander, Colombia
| | - Gustavo Nigenda
- Universidad Autónoma del Estado de Morelos, Cuernavaca, Morelos, México
| | - Anahí Dreser
- Centro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
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13
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Rayes IK, Abduelkarem AR. A qualitative study exploring physicians' perceptions on the role of community pharmacists in Dubai. Pharm Pract (Granada) 2016; 14:738. [PMID: 27785161 PMCID: PMC5061517 DOI: 10.18549/pharmpract.2016.03.738] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 08/31/2016] [Indexed: 11/14/2022] Open
Abstract
Objective: The aim of this study is to explore the perceptions of physicians operating within the boundaries of Dubai on the role of community pharmacists. Methods: Semi-structured interviews were done with 12 physicians working within the boundaries of Dubai Health Authority. Interviews mainly focused on understanding the perceptions of physicians on the role of community pharmacists in addition to willingness to integrating pharmacists in patient care process. Results: Key findings show that all interviewees agree that community pharmacists are important healthcare professionals. However, 7 physicians restrict the role of pharmacists to dispensing medicines. Physicians in Dubai are willing to collaborate with pharmacists, but more than half of them (7) think that pharmacists might interfere with their jobs. Conclusion: The study concludes that all informants agree that collaboration between community pharmacists and physicians definitely enhances patients’ drug therapy outcomes.
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Affiliation(s)
- Ibrahim K Rayes
- Assistant Professor, Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy and Health Sciences, Ajman University of Science and Technology . Ajman ( United Arab Emirates ).
| | - Abduelmula R Abduelkarem
- Associate Professor, Department of Pharmacy Practice and Pharmaco-therapeutics, College of Pharmacy, University of Sharjah . Sharjah ( United Arab Emirates ).
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14
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Saleem F, Hassali MA. The true picture of dispensing separation in Malaysia. Res Social Adm Pharm 2016; 12:173-174. [DOI: 10.1016/j.sapharm.2015.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 08/11/2015] [Indexed: 11/28/2022]
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15
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Abstract
Antibiotic stewardship is a key strategy for limiting antibiotic resistance. Over the last decade the South Korean government has implemented a series of healthcare policies directed to this end, consisting of legislative separation of drug prescribing and dispensing, antibiotic utilization reviews, healthcare quality assessment, and public reporting. As a result, the proportion of antibiotic prescriptions for acute upper respiratory tract infections in primary healthcare facilities decreased from 72.9% in 2002 to 42.7% in 2013. However, no significant decrease in antibiotic resistance occurred over the same period in clinically important bacteria such as Streptococcus pneumoniae. These government-driven policies played a pivotal role in improving antibiotic use for outpatients and surgical patients in South Korea. However, to achieve long-lasting successful outcomes, coordinated efforts and communications among the stakeholders, including physicians and medical societies, are needed.
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Affiliation(s)
- Baek Nam Kim
- Department of Internal Medicine, Inje University Sanggye-Paik Hospital, Seoul, Korea
| | - Hong Bin Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Myoung Don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
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Yuk SM, Han KT, Kim SJ, Kim W, Sohn TY, Jeon B, Kim YM, Park EC. Consumption of pharmaceutical drugs in exception region of separation for drug prescribing and dispensing program in South Korea. Subst Abuse Treat Prev Policy 2015; 10:36. [PMID: 26376979 PMCID: PMC4572639 DOI: 10.1186/s13011-015-0032-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 09/10/2015] [Indexed: 11/23/2022]
Abstract
Background In the year 2000, the South Korean government introduced a program for separation of drug prescribing and dispensing. The goals of the program are to reduce misuse of drugs and to contain drug expenditures. The government also designated exception regions for the program to reduce the inconvenience for people who reside in areas with a shortage of health care resources. However, according to government reports, many adverse events related to drug misuse occurred in these exception regions after the program reforms were introduced. Therefore, it is worth investigating the factors that relate to drug consumption so that misuse in exception regions can be reduced. Methods Data from medical institutions, detailed drug supply data, and community health survey data were included in the analysis. Multilevel linear regression analysis using mixed models that included pharmacy—and regional-level variables were used to examine the associations regarding the percentages of drug types consumed (i.e., antipyretic, analgesic, anti-inflammatory drugs, psychotropic drugs, adrenal cortical hormones, and antibiotics). Results The data used in this analysis were from a total of 16,455 pharmacies. There were 1.9 % pharmacies from program exception regions and 98.1 % pharmacies from program application regions. Compared with the pharmacies in the program application regions, the exception region pharmacies had higher values for percent consumption of the antipyretic, analgesic, anti-inflammatory drugs category, and of the adrenal cortical hormones category (antipyretic, analgesic, anti-inflammatory drugs = β: 3.19, Standard Error (SE): 0.82, t: 3.88, p-value < 0.05; adrenal cortical hormones = β: 0.72, SE: 0.07, t: 9.92, p-value < 0.05). Conclusion Our results suggested that pharmacies in exception regions supplied more antipyretic, analgesic, anti-inflammatory drugs, and more adrenal cortical hormones compared with the pharmacies where separation of drug prescribing and dispensing had been implemented. Health care professionals and health policy makers should consider management of health care expenditure by the category of drugs consumed, especially in program exception regions.
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Affiliation(s)
- Sang Mi Yuk
- Department of Health Policy and Management, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea. .,Health Insurance Review and Assessment Service, Seoul, Republic of Korea.
| | - Kyu-Tae Han
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea. .,Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Sun Jung Kim
- Department of Health Administration and Management, College of Medical Science, Soonchunhyang University, Asan, Korea.
| | - Woorim Kim
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea. .,Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Tae Yong Sohn
- Department of Health Services Administration, Yuhan University, Bucheon, Republic of Korea.
| | - Byungyool Jeon
- Department of Preventive Medicine, CHA University, Pochon, Republic of Korea.
| | - Young-Man Kim
- Gyeonggi Infectious Disease Control Center, Seongnam, Republic of Korea.
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea. .,Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Alabid AHMA, Ibrahim MIM, Hassali MAA. Dispensing Practices of General Practitioners and Community Pharmacists in Malaysia-A Pilot Study. Journal of Pharmacy Practice and Research 2015. [DOI: 10.1002/j.2055-2335.2013.tb00251.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Alamin Hassan MA Alabid
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences; Universiti Sains Malaysia
| | | | - Mohamed Azmi A Hassali
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences; Universiti Sains Malaysia; Penang Malaysia
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Abstract
We investigate if demand for branded prescription medications in post-patent markets is patient- or doctor driven. When drugs go off-patent the brand medication often maintains non-negligible market shares. We use population-wide Danish data including all prescriptions for seven blockbuster drugs from 1998 to 2008, which amounts to 13,415,012 prescriptions. At the outset, descriptive statistics suggest large variation in drug choice over doctors. Nonetheless, using a two-way fixed effects model we find that the primary determinants of brand drug use are unobserved patient characteristics and price effects.
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Cho MH, Yoo KB, Lee HY, Lee KS, Kwon JA, Han KT, Kim JH, Park EC. The effect of new drug pricing systems and new reimbursement guidelines on pharmaceutical expenditures and prescribing behavior among hypertensive patients in Korea. Health Policy 2015; 119:604-11. [PMID: 25630635 DOI: 10.1016/j.healthpol.2015.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 01/04/2015] [Accepted: 01/06/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the effects of a new drug-pricing system (January 2012) and new prescription and reimbursement guidelines (January 2013) on hypertension-related pharmaceutical expenditures and prescribing behaviors in Korea. METHODS In all, 11,298 clinics and 2,667,132 patients with hypertension were included in our study. As dependent variables, we used the drug cost per patient, drug cost per prescribed day, number of drugs per prescription, number of prescribed days per visit, number of visits, number of original (vs. generic) drugs prescribed, and the percentage of original drug cost. Clinic characteristics and patients' age and sex were used as independent variables. Multi-level mixed-effect regression models were used. RESULTS The drug cost per patient decreased by -1446 KRW$ (-7.4%; p<0.001) in Q4 2012 and by -1833 (-9.3%; p<0.001) in Q2 2013 compared with Q4 2011. Number of drugs per prescription decreased significantly. The percentage of original drug cost and the number of original drugs also declined. CONCLUSION Reforms to the drug pricing policy and the new guidelines may reduce pharmaceutical expenditures without increasing number of drugs per prescription and the number of original drug used. Policy makers should consider the comprehensive effects of implementing new policies on both drug prices and consumption.
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Affiliation(s)
- Mee-Hyun Cho
- Health Insurance Review and Assessment Service, Republic of Korea
| | - Ki-Bong Yoo
- Department of Healthcare Management, Eulji University, Republic of Korea
| | - Hoo-Yeon Lee
- Department of Social Medicine, Dankook University, Republic of Korea
| | - Kwang-Sig Lee
- Department of Public Health, Graduate School, Yonsei University, Republic of Korea; Institute of Health Services Research, Yonsei University, Republic of Korea
| | - Jeoung A Kwon
- National Cancer Control Institute, National Cancer Center, Republic of Korea
| | - Kyu-Tae Han
- Department of Public Health, Graduate School, Yonsei University, Republic of Korea; Institute of Health Services Research, Yonsei University, Republic of Korea
| | - Jae-Hyun Kim
- Department of Public Health, Graduate School, Yonsei University, Republic of Korea; Institute of Health Services Research, Yonsei University, Republic of Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Republic of Korea; Department of Preventive Medicine, College of Medicine Yonsei University, Republic of Korea.
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Lim S, Lee KH, Suh HS, Bae KH. To whom do bureaucrats need to respond? Two faces of civil society in health policy. Soc Sci Med 2014; 123:269-77. [DOI: 10.1016/j.socscimed.2014.10.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 09/15/2014] [Accepted: 10/14/2014] [Indexed: 11/29/2022]
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Rischatsch M. Lead me not into temptation: drug price regulation and dispensing physicians in Switzerland. Eur J Health Econ 2014; 15:697-708. [PMID: 23864366 DOI: 10.1007/s10198-013-0515-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 06/26/2013] [Indexed: 06/02/2023]
Abstract
While most countries separate drug prescription and dispensation to ensure independent drug choice, some allow this combination to increase pharmaceutical access in rural areas or to increase the utilization of pharmacist skills. A drawback of this approach is that dispensing physicians or prescribing pharmacists may be incentivized to increase their own profits through the prescription of cost-inefficient drug packages, leading to an increase in pharmaceutical spending. Switzerland constitutes an interesting example of where dispensing and non-dispensing physicians coexist, permitting a comparison of their prescribing behavior. The present study shows that drug margin optimization is possible under the current drug price regulation scheme in Switzerland. Using drug claims data, empirical findings indicate a 5-10% higher margin per dose for dispensing physicians compared to pharmacists. Cost per dose is 3-5% higher when dispensed by physicians instead of pharmacists.
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Pérez-Cuevas R, Doubova SV, Wirtz VJ, Servan-Mori E, Dreser A, Hernández-Ávila M. Effects of the expansion of doctors' offices adjacent to private pharmacies in Mexico: secondary data analysis of a national survey. BMJ Open 2014; 4:e004669. [PMID: 24852298 PMCID: PMC4039785 DOI: 10.1136/bmjopen-2013-004669] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To compare the sociodemographic characteristics, reasons for attending, perception of quality and associated out-of-pocket (OOP) expenditures of doctors' offices adjacent to private pharmacies (DAPPs) users with users of Social Security (SS), Ministry of Health (MoH), private doctor's offices independent from pharmacies and non-users. SETTING Secondary data analysis of the 2012 National Survey of Health and Nutrition of Mexico. PARTICIPANTS The study population comprised 25 852 individuals identified as having had a health problem 15 days before the survey, and a random sample of 12 799 ambulatory health service users. OUTCOME MEASURES Sociodemographic characteristics, reasons for attending healthcare services, perception of quality and associated OOP expenditures. RESULTS The distribution of users was as follows: DAPPs (9.2%), SS (16.1%), MoH (20.9%), private providers (15.4%) and non-users (38.5%); 65% of DAPP users were affiliated with a public institution (MoH 35%, SS 30%) and 35% reported not having health coverage. DAPP users considered the services inexpensive, convenient and with a short waiting time, yet they received ≥3 medications more often (67.2%, 95% CI 64.2% to 70.1%) than users of private doctors (55.7%, 95% CI 52.5% to 58.6%) and public institutions (SS 53.8%, 95% CI 51.6% to 55.9%; MoH 44.7%, 95% CI 42.5% to 47.0%). The probability of spending on consultations (88%, 95% CI 86% to 89%) and on medicines (97%, 95% CI 96% to 98%) was much higher for DAPP users when compared with SS (2%, 95% CI 2% to 3% and 12%, 95% CI 11% to 14%, respectively) and MoH users (11%, 95% CI 9% to 12% and 32%, 95% CI 30% to 34%, respectively). CONCLUSIONS DAPPs counteract current financial protection policies since a significant percentage of their users were affiliated with a public institution, reported higher OOP spending and higher number of medicines prescribed than users of other providers. The overprescription should prompt studies to learn about DAPPs' quality of care, which may arise from the conflict of interest implicit in the linkage of prescribing and dispensing processes.
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Affiliation(s)
- Ricardo Pérez-Cuevas
- Division of Social Protection and Health, Inter-American Development Bank, Mexico, Mexico
| | - Svetlana V Doubova
- Epidemiology and Health Services Research Unit, CMN Siglo XXI, Mexican Institute of Social Security, Mexico, Mexico
| | - Veronika J Wirtz
- Center for Global Health and Development (CGHD), Boston University, Boston, Massachusetts, USA
- Centre for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Edson Servan-Mori
- Centre for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Anahí Dreser
- Centre for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
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Alabid AHMA, Ibrahim MIM, Hassali MA. Antibiotics Dispensing for URTIs by Community Pharmacists (CPs) and General Medical Practitioners in Penang, Malaysia: A Comparative Study using Simulated Patients (SPs). J Clin Diagn Res 2014; 8:119-23. [PMID: 24596741 DOI: 10.7860/jcdr/2014/6199.3923] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Accepted: 09/19/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND In Malaysia, doctors in private clinics (often called dispensing doctors) are permitted to dispense medicines. This potentially may compromise rational dispensing of medicines in general and antibiotics in particular. AIM This study explored, assessed and compared dispensing of antibiotics between Community Pharmacist (CP) and General Practitioners (GPs) regarding symptomatic diagnosis, antibiotic categories, adherence to therapeutic doses and promotion of generic antibiotics. METHOD The study used trained Simulated Patients (SPs), who used a scenario of common cold symptoms at GP private clinics and community pharmacies to observe and explore the practice of antibiotics dispensing. The study was conducted within the period of May to September 2011 in Penang, Malaysia. The data was analysed using descriptive statistics, Chi-square and Fisher's Exact Tests at alpha level of 0.05. RESULTS GPs dispensed more antibiotics than CPs (p= 0.001) for common cold symptoms. They dispensed more Amoxicillin (n = 14, 35%) than CPs (n = 11, 11%) (p < 0.001) and more Tetracycline (n = 3, 7.5%) while no CP dispensed this category (p = 0.022). On the other hand, CPs (n = 11, 11%) suggested brand antibiotics where as GPs dispensed only generic antibiotics (p < 0.001). Generally GPs comply better with the symptomatic diagnosis standard e.g. when asking SPs about the symptoms they had, all GPs (n = 40, 100%) complied better with this standard. Despite that, they dispensed more antibiotics (n = 26, 65%) than CPs (n = 29, 29%) (p = 0.001). GPs (n = 22, 55%) also are better than CPs (n = 16, 16%) in adherence to therapeutic doses (p< 0.001). CONCLUSION Findings showed poor adherence to rational dispensing of antibiotics by both providers. Although, GPs adhere better to symptomatic diagnosis and therapeutic dosing of antibiotics than CPs, they unnecessarily prescribe and dispense more antibiotics for Upper respiratory tract infection (URTI) symptoms. Establishing prescription guidance and regulatory actions, especially for URTIs treatment, and separating of medication dispensing are seemed to be crucial steps for the reform.
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Affiliation(s)
- Alamin Hassan M A Alabid
- PhD Candidate, Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences Universiti Sains Malaysia Penang, Malaysia
| | - Mohamed Izham Mohamed Ibrahim
- Professor of Social & Administrative Pharmacy, Associate Dean of Research & Graduate Studies Affairs, College of Pharmacy , P.O. Box 2713, Qatar University, Doha, Qatar
| | - Mohamed Azmi Hassali
- Professor of Social & Administrative Pharmacy, Associate Dean of Research & Graduate Studies Affairs, College of Pharmacy , P.O. Box 2713, Qatar University, Doha, Qatar
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Kwon HY, Hong JM, Godman B, Yang BM. Price cuts and drug spending in South Korea: the case of antihyperlipidemic agents. Health Policy 2013; 112:217-26. [PMID: 24075008 DOI: 10.1016/j.healthpol.2013.08.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 08/26/2013] [Accepted: 08/30/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To identify the effect of price control policies on drug expenditure in South Korea. METHODS We retrospectively examined the effects of price-reduction policies on drug expenditures, in particular regarding anti-hyperlipidemic drugs. The National Health Insurance claims data for a 60-month period between 2006 and 2010 were analysed. A segmented regression analysis was conducted with three intervention variables: July 2008, April 2009, and January 2010. RESULTS Despite three rounds of price cuts, monthly drug expenditures increased by KRW 599.67 million (USD 523,726) after the third intervention (p=0.0781). The trend in volume increased consistently, but not significantly. The unit prices showed a steady downward trend over time, but rebounded after the third price cut. The number of patients with hyperlipidemia more than doubled to 3729 (p=0.0801) per month after the entry of generics for atorvastatin in July 2008. CONCLUSION Extensive price controls did not effectively suppress the growth of pharmaceutical expenditures. The increased number of patients, attributable to the newly launched generic drug atorvastatin, and the increased use of expensive drugs were major factors affecting the increase in drug spending. Policies that regulate both drug prices and utilisation, and that reduce financial burdens via enhanced use of generics need to be introduced.
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Affiliation(s)
- Hye-Young Kwon
- Institute of Health and Environment, Seoul National University, Seoul, South Korea
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Abstract
OBJECTIVES To determine the factors contributing to the use of over-the-counter (OTC) drugs and to examine the relationship between the purchase of OTC drugs and the utilization of health care services in South Korea. METHODS This study used data from the 2008 Korea Health Panel Survey. The respondents were classified according to the purpose of the OTC drug use. The first group (n = 364) included respondents who had purchased OTC drugs for self-medication, and the second group (n = 955) included respondents who had taken OTC drugs for nutrition for more than 3 months. Logistic regression analyses were conducted to identify the factors contributing to the purchase of OTC drugs. RESULTS The self-medication group was more likely to be older and to have a chronic disease. In addition, the purchase of OTC drugs was related to the utilization of other health care services. The more outpatient services at clinics were used, the more the respondents tended to purchase OTC drugs for self-medication and nutrition. As hospital outpatient visits increased, however, the purchase of OTC drugs for self-medication decreased and the purchase of OTC drugs for nutrition increased. CONCLUSIONS This study shows that age and chronic disease are the major factors related to using OTC drugs for self-medication for long-term periods. Furthermore, this study suggests that the use of outpatient services is one of the factors associated with purchasing OTC drugs. Considering the potential adverse effects of OTC drugs, communication between physicians and patients should be encouraged at outpatient visits.
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Affiliation(s)
- Ja-Hyun Cho
- Graduate School of Public Health, Seoul National University, Seoul, South Korea
| | - Tae-Jin Lee
- Graduate School of Public Health, Seoul National University, Seoul, South Korea.
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Lafi R, Robinson S, Williams I. Economic evaluation and the Jordan Rational Drug List: an exploratory study of national-level priority setting. Value Health 2012; 15:771-776. [PMID: 22867788 DOI: 10.1016/j.jval.2012.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Revised: 02/19/2012] [Accepted: 04/07/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To explore the extent of and barriers to the use of economic evaluation in compiling the Jordan Rational Drug List in the health care system of Jordan. METHODS The research reported in this article involved a case study of the Jordan Rational Drug List. Data collection methods included semi-structured interviews with decision makers and analysis of secondary documentary sources. The case study was supplemented by additional interviews with a small number of Jordanian academics involved in the production of economic evaluation. RESULTS The research found that there was no formal requirement for cost-effectiveness information submitted as part of the decision-making process for the inclusion of new technologies on the Jordan Rational Drug List. Both decision makers and academics suggested that economic evidence was not influential in formulary decisions. This is unusual for national formulary bodies. The study identified a number of barriers that prevent substantive and routine use of economic evaluation. While some of these echo findings of previous studies, others-notably the extent to which the sectional interests of clinical groups and commercial (pharmaceutical) industry exert undue influence over decision making-more obviously result from the specific Jordanian context. CONCLUSIONS Economic evaluation was not found to be influential in the Jordan Rational Drug List. Recommendations for improvement include enhancing capacity in relation to generating, accessing, and/or applying health economic analysis to priority setting decisions. There is a further need to incentivize the use of economic evaluation, and this requires that organizational and structural impediments be removed.
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Affiliation(s)
- Rania Lafi
- Health Services Management Centre, University of Birmingham, UK
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Liu YM, Yang YHK, Hsieh CR. Regulation and competition in the Taiwanese pharmaceutical market under national health insurance. J Health Econ 2012; 31:471-483. [PMID: 22525716 DOI: 10.1016/j.jhealeco.2012.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Revised: 02/27/2012] [Accepted: 03/13/2012] [Indexed: 05/31/2023]
Abstract
This article investigates the determinants of the prices of pharmaceuticals and their impact on the demand for prescription drugs in the context of Taiwan's pharmaceutical market where medical providers earn profit directly from prescribing and dispensing drugs. Based on product-level data, we find evidence that the profit-seeking behavior of the medical providers in the prescription drug market transfers the force of competition from the unregulated wholesale market to the regulated retail market and hence market competition still plays an important role in the determination of the regulated price. We also find that the profit-seeking behavior plays a similar role to advertising in that it increases the brand loyalty and hence lowers price elasticity. An important implication of our study is that the institutional features in the pharmaceutical market matter in shaping the nature of pharmaceutical competition and the responsiveness of pharmaceutical consumption with respect to changes in price.
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Affiliation(s)
- Ya-Ming Liu
- Department of Economics, College of Social Sciences, National Cheng-Kung University, 1 University Road, Tainan, 70101 Taiwan.
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Shin E, Lee C, Kim J, Kim KJ. Patient satisfaction versus political support: Korea's drug-dispensing law revisited. J Korean Med Assoc 2012. [DOI: 10.5124/jkma.2012.55.7.676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Euichul Shin
- Department of Preventive Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Changwoo Lee
- Korea Insurance Research Institute, Seoul, Korea
| | - Jinkyung Kim
- Department of Hospital Management, Konyang University, Daejeon, Korea
| | - Kwang Jum Kim
- Graduate School of Healthcare and Policy, The Catholic University of Korea, Seoul, Korea
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Affiliation(s)
- Zaheer-Ud-Din Babar
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
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Chang KH. The healer or the druggist: effects of two health care policies in Taiwan on elderly patients' choice between physician and pharmacist services. Int J Health Care Finance Econ 2009; 9:137-152. [PMID: 19357949 DOI: 10.1007/s10754-009-9059-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Accepted: 03/21/2009] [Indexed: 05/27/2023]
Abstract
When both physicians and pharmacists in Taiwan prescribed and dispensed drugs, many elderly people considered the two types of health care providers more or less synonymous (i.e., close substitutes). Two policies mandated in the 1990 s changed this perception: National Health Insurance (NHI), which provides insurance coverage to all citizens, and a separation policy (SP) that forbid physicians from dispensing and pharmacists from prescribing drugs. The author finds that by providing an economic incentive to the previously uninsured elderly, NHI raised the probability that they would visit physicians, relative to their continuously insured counterparts. In particular, some previously uninsured elderly who once only visited pharmacists were more likely to also visit physicians after NHI was implemented. Following this, the SP made it more likely that all elderly patients would only visit physicians and buy drugs from on-site pharmacists hired by physicians--a result different than its policy goal.
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Affiliation(s)
- Kang-Hung Chang
- Department of Economics, Michigan State University, 110 Marshall-Adams Hall, East Lansing, MI 48824, USA.
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Lim D, Emery J, Lewis J, Sunderland VB. A systematic review of the literature comparing the practices of dispensing and non-dispensing doctors. Health Policy 2009; 92:1-9. [PMID: 19269055 DOI: 10.1016/j.healthpol.2009.01.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2008] [Revised: 01/28/2009] [Accepted: 01/31/2009] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Some doctors perform the dual roles of prescribing and dispensing pharmaceuticals. The dispensing doctors (DDs) role may give rise to prescribing behaviours that vary from those of non-DDs. The aim of this review was to systematically and comparatively appraise the research evidence related to the practices of DDs. METHODS A systematic search of bibliographic databases and reference lists from selected papers were the sources of the data. Inclusion criteria were papers published in English, between 1970 and 2008 that provided quantitative data comparing the practices of DDs and non-DDs. At least two of the authors abstracted data from all eligible papers using a purpose-made data extraction form. RESULTS Twenty-one papers were included in this review. Evidence indicated that DDs prescribed more pharmaceutical items and less often generically than non-DDs. There was limited evidence to suggest that DDs prescribed less judiciously and were associated with poor dispensing standards. Patient convenience and access to pharmaceuticals were main reasons for doctors to dispense. CONCLUSION DDs can fill an important gap in the provision of pharmaceuticals for their patients especially where health workforce shortages exist. There was evidence the dispensing role influenced prescribing. Patient convenience should be balanced against scarce medical resources, being utilised for dispensing.
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Affiliation(s)
- David Lim
- School of Public Health, Curtin University of Technology, GPO Box U1987, Perth 6845, Australia.
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Affiliation(s)
- Wen-Shyong Liou
- School of Pharmacy, National Defense Medical Center, Taipei, Taiwan.
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33
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Kwon S. Thirty years of national health insurance in South Korea: lessons for achieving universal health care coverage. Health Policy Plan 2008; 24:63-71. [DOI: 10.1093/heapol/czn037] [Citation(s) in RCA: 309] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
Weather watch/warning systems have been established for human health outcomes. Our study aims to develop and demonstrate a weather watch/warning system for asthma and stroke within the whole of South Korea, using a stratified regression approach. We converted claim-based health insurance data covering almost all medical claims for the only health insurance system in Korea for asthma and stroke from 1996-2003 into personalized disease episode data, and combined them with meteorological data. We utilized a step-wise regression method using factors extracted from the meteorological data to develop stratified models for six (stroke) and nine (asthma) regional and day-of-week strata. Validation studies showed that the actual number of hospitalizations in 2003 increased according to the three-leveled predictions (levels I, II, and III) from the model based on the 1996-2002 data. This system is accessible via the internet (http://industry.kma.go.kr/APP/sub_APP15_H01.htm) at the Korean Meteorological Administration website.
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Affiliation(s)
- Jaiyong Kim
- Korean Health Insurance Review Agency, Seoul, Korea
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The Effects of Professional Autonomy and Ideology on Occupational Satisfaction among Korean Physicians. Korean Journal of Health Policy and Administration 2008; 18:63-84. [DOI: 10.4332/kjhpa.2008.18.1.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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36
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Affiliation(s)
- Hak-Ju Kim
- Hak-Ju Kim is chair and assistant professor of social welfare in the Department of Social Welfare at Dongguk University in Seoul, South Korea. Jennifer Prah Ruger is an assistant professor in the Department of Epidemiology and Public Health, Division of Health Policy and Administration, at the Yale University School of Medicine in New Haven, Connecticut
| | - Jennifer Prah Ruger
- Hak-Ju Kim is chair and assistant professor of social welfare in the Department of Social Welfare at Dongguk University in Seoul, South Korea. Jennifer Prah Ruger is an assistant professor in the Department of Epidemiology and Public Health, Division of Health Policy and Administration, at the Yale University School of Medicine in New Haven, Connecticut
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Kinoshita H, Kobayashi Y, Fukuda T. Duplicative medications in patients who visit multiple medical institutions among the insured of a corporate health insurance society in Japan. Health Policy 2008; 85:114-23. [PMID: 17728002 DOI: 10.1016/j.healthpol.2007.07.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2006] [Revised: 06/30/2007] [Accepted: 07/07/2007] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objective of this paper is to describe the frequency of duplicative medication use and to estimate the drug cost associated with duplicative medications in patients who visit multiple medical institutions in Japan. METHODS The subjects of this study were insurants of a corporate health insurance society. We examined claims of insurants who received prescriptions from multiple medical institutions in April 2002. We examined characteristics of insurants who received duplicative medications and calculated the cost of duplicated drugs. RESULTS 8.8% received drugs with the same mechanism of action for overlapping administration periods. In terms of comparison among three age groups, 0-19 years old, 20-69 years old, and 70 years old or older, the percentage was higher in 0-19-year-old patients than in the other age groups. The cost of duplicated drugs was found to be 0.7% or 0.5% of the total drug cost, when calculated with higher-priced drugs and lower-priced drugs, respectively. CONCLUSIONS This study suggests that pediatric and teenage patients as well as elderly patients require prudent management of medication to avoid duplicative medications and that at least an estimated 5.2-7.2 billion yen may be saved if duplicative medications can be completely eliminated nationwide.
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Affiliation(s)
- Hiroki Kinoshita
- Department of Public Health, Graduate School of Medicine, University of Tokyo, Japan.
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Abstract
The health systems of Japan and the Asian Tigers (Hong Kong, Korea, Singapore and Taiwan), and the recent reforms to them, provide many potentially valuable lessons to East Asia's developing countries. All five systems have managed to keep a check on health spending despite their different approaches to financing and delivery. These differences are reflected in the progressivity of health finance, but the precise degree of progressivity of individual sources and the extent to which households are vulnerable to catastrophic health payments depend on the design features of the system - the height of any ceilings on social insurance contributions, the fraction of health spending covered by the benefit package, the extent to which the poor face reduced copayments, whether there are caps on copayments, and so on. On the delivery side, too, Japan and the Tigers offer some interesting lessons. Singapore's experience with corporatizing public hospitals - rapid cost and price inflation, a race for the best technology, and so on - illustrates the difficulties of corporatization. Korea's experience with a narrow benefit package illustrates the danger of providers shifting demand from insured services with regulated prices to uninsured services with unregulated prices. Japan, in its approach to rate setting for insured services, has managed to combine careful cost control with fine-tuning of profit margins on different types of care. Experiences with DRGs in Korea and Taiwan point to cost-savings but also to possible knock-on effects on service volume and total health spending. Korea and Taiwan both offer important lessons for the separation of prescribing and dispensing, including the risks of compensation costs outweighing the cost savings caused by more 'rational' prescribing, and cost-savings never being realized because of other concessions to providers, such as allowing them to have onsite pharmacists.
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Abstract
BACKGROUND In Taiwan, a policy of separation of prescribing and dispensing practices of practitioners at Western medical and dental clinics was implemented on an incremental basis in 1997. The purpose of this policy was to promote pharmacists' autonomy and increase the transparency and safety of prescribing medications. To avoid profit loss from no longer being able to dispense prescription medications, some clinics opened pharmacies located under the same roof as the clinic ("next-door" pharmacies) or hired an on-site pharmacist. This practice might compromise pharmacists' professional autonomy and patients' benefit in pharmaceutical care. OBJECTIVE The aim of the current study was to clarify the relationship between practicing pharmacies and clinics that resulted from contracts between pharmacies and the Bureau of National Health Insurance from 1996 to 2004. METHODS The National Health Research Institutes database in Taiwan supplied the complete claims data sets of practicing pharmacies from 1997 to 2004. The prescribing source of every dispensed prescription was used to calculate the 1-firm concentration ratio (CR-1) (ie, the proportion of prescriptions issued by the largest prescribing clinic/hospital in the total number of dispensed prescriptions of a pharmacy in each year). Similar processing was applied to the clinics. We identified each clinic's largest cooperating pharmacy and compared their CR-1s. Pharmacies that dispensed >900 prescriptions/mo during the study period were considered thriving. Pharmacies with a CR-1 > or =0.99 and whose largest cooperating clinic had a CR-1 > or =0.99 were considered to have a close business relationship, possibly indicating a next-door pharmacy. RESULTS The total number of prescriptions dispensed at all pharmacies in the database grew from 226,901 in 1996 to 59,785,039 in 2004, and the number of pharmacies, from 481 to 3529. An increasing number of pharmacies had a higher CR-1 after 1999. We found that most prescriptions could be dispensed at only 1 pharmacy during the study period. In 2004, 1429 clinics had >900 prescriptions/mo dispensed externally and a CR-1 > or =0.99. They had released 75.8% of all prescriptions to be dispensed at practicing pharmacies; 811 of these clinics had a cooperating pharmacy with a CR-1 > or =0.99. CONCLUSIONS In this data analysis in Taiwan, most prescriptions from practitioners at Western medical and dental clinics could be dispensed at only 1 pharmacy during the study period, suggesting that pharmacists' professional autonomy and the patients' benefit in pharmaceutical care might be compromised in Taiwan.
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Affiliation(s)
- Tzeng Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan.
| | - Li-Fang Chou
- Department of Public Finance, National Chengchi University, Taipei, Taiwan
| | - Shinn Jang Hwang
- Department of Family Medicine, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan
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Abstract
There is growing interest in comparing patterns of social and health service development in advanced Asian economies. Most publications concentrate broadly on a range of core social services such as education, housing, social security and health care. In terms of those solely focused on health, most discuss arrangements in specific countries and territories. Some take a comparative approach, but are focused on presentation and discussion of expenditure, resourcing and service utilization data. This article extends the comparative analysis of advanced Asian health systems, considering the cases of Japan, South Korea, Taiwan, Hong Kong and Singapore. The article provides basic background information, and delves into common concerns among the world's health systems today including primary care organization, rationing and cost containment, service quality, and system integration. Conclusions include that problems exist in 'classifying' the five diverse systems; that the systems face common pressures; and that there are considerable opportunities to enhance primary care, service quality and system integration.
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Affiliation(s)
- Robin Gauld
- Department of Preventive and Social Medicine, University of Otago, PO Box 913, Dunedin, New Zealand.
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Abstract
Korea recently introduced three major health care reforms: in financing (1999), pharmaceuticals (2000), and provider payment (2001). In these three reforms, new government policies merged more than 350 health insurance societies into a single payer, separated drug prescribing by physicians from dispensing by pharmacists, and attempted to introduce a new prospective payment system. This essay compares the three reforms in Korea and draws important lessons about the country's changing process and politics of health care policy. The change of government, the president's keen interest in health policy, and democratization in the public policy process toward a more pluralist context opened a policy window for reform. Civic groups played an active role in the policy process by shaping the proposals for reform-a major change from the previous policy process that was dominated by government bureaucrats. The three reforms also showed important differences in the role of interest groups. Strong support by the rural population and labor unions contributed to the financing reform. In the pharmaceutical reform, which was a big threat to physician income, the president and civic groups succeeded in quickly setting the reform agenda; the medical profession was unable to block the adoption of the reform but their strikes influenced the content of the reform during implementation. Physician strikes also helped block the implementation of the payment reform. Future reform efforts in Korea will need to consider the political management of vested interest groups and the design of strategies for both scope and sequencing of policy reforms.
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Abstract
In 1999, the Korean government made a drug pricing policy reform to improve the efficiency and transparency of the drug distribution system. Yet, its policy formation process was far from being rational. Facing harsh resistance from various interest groups, the government changed its details into something different from what was initially investigated and planned. So far, little evidence supports any improvement in Korea's drug distribution system. Instead, the new drug pricing policy has deteriorated Korea's national health insurance budget, indicating a heavier economic burden for the general public. From Korea's experience, we may draw some lessons for the future development of a better health care system. As a society becomes more pluralistic, the government should come out of authoritarianism and thoroughly prepare in advance for resistance to reform, by making greater efforts to persuade strong interest groups while informing the general public of potential benefits of the reform. Additionally, facing developing civic groups, the government should listen but not rely too much on them at the final stage of the policy formation. Many of the civic groups lack expertise to evaluate the details of policy and tend to act in a somewhat emotional way.
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Affiliation(s)
- Woojin Chung
- Department of Health Policy and Management, Graduate School of Public Health, Yonsei University, Seoul, Korea
| | - Han Joong Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
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Lee KS, Brouwer WBF, Lee SI, Koo HW. Introducing economic evaluation as a policy tool in Korea: will decision makers get quality information? : a critical review of published Korean economic evaluations. Pharmacoeconomics 2005; 23:709-21. [PMID: 15987227 DOI: 10.2165/00019053-200523070-00005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Interest in the use of economic evaluations in Korea as an aid for healthcare decision makers has been growing rapidly since the financial crisis of the Korean National Health Insurance fund and the separation in 2000 of the roles of prescribing and dispensing drugs. The Korean Health Insurance Review Agency (HIRA) is considering making it mandatory for pharmaceutical companies to submit the results of an economic evaluation when demanding reimbursement of new pharmaceuticals. The usefulness of the results of economic evaluations depends highly on the quality of the studies. The purpose of this paper, therefore, is to provide a critical review of economic evaluations of healthcare technologies published in the Korean context. Our results show that many studies did not meet international standards. Study designs were suboptimal, study perspectives and types were often stated incompletely, time periods were often too short, and outcome measures were often less than ideal. In addition, some articles did not distinguish between measurement and valuation of resource use. Capital, overhead and productivity costs were often omitted. Only half of the studies performed sensitivity analyses. In order to further rationalise resource allocation in the Korean healthcare sector, the quality of the information provided through economic evaluations needs to improve. Developing clear guidelines and educating and training researchers in performing economic evaluations is necessary.
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Affiliation(s)
- Kun-Sei Lee
- Department of Health Policy and Management and Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands.
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