심사기준 적용에 따른 의약품 처방행태 변화

Abstract

[한글]

본 연구는 심사기구인 건강보험심사평가원에서 진료비 심사의 도구로 활용하고 있는 심사기준의 적용에 따른 진료행태의 변화를 파악하고자 하였으며, 소화기관용 약제에 대한 처방행태의 변화분석을 통하여 연구하고자 하였다.

연구대상자료는 본 연구에서는 분석단위가 의사이므로 환자의 특성을 보정하여 분석하고자 하였으며, 소화기관용 약제 심사기준 적용 전인 2002년 5월과 적용 후인 7월의 진료자료가 모두 있는 내과계 의과 의원급 요양기관 중 의사 2인 이상 요양기관과 수술환자는 제외하고, 위궤양(K25) 또는 십이지장궤양(K26)으로 외래에서 소화기관용 약제를 처방받고 심사기준 적용 전?후 시점 모두 내원한 환자가 5인 이상 되는 요양기관(183개)의 심사청구 자료를 분석한 결과는 다음과 같다.

1. 심사기준 적용에 따른 처방행태의 변화는 다음과 같다

첫째, 환자당 약제비는 소화기관용 약제의 심사기준 적용 전에 비해 적용 후에는 낮아졌으나 심사기준 적용 전과 후의 차이는 통계적으로 유의하지 아니하였다.

둘째, 내원일당 약제비는 심사기준 적용 전에 비해 적용 후에 높아졌으나 심사기준 적용 전과 후의 차이는 통계적으로 유의하지 아니하였다. 그러나 내원일수가 심사기준 적용 후에 감소되었다.

셋째, 환자당 총약품목수는 심사기준 적용 전에 비해 적용 후에 감소하였으며, 심사기준 적용 전과 후의 차이는 통계적으로 유의하였다.

2. 의사 및 요양기관 특성별로 살펴본 심사기준 적용에 따른 처방행태의 변화는 다음과 같다.

첫째, 환자당 총약제비는 표시과목(내과, 가정의학과, 일반의)과 개원기간(1년 미만, 1년 이상)에 따른 처방행태의 차이가 통계적으로 유의한 차이를 보였다. 의사의 연령(39세 이하, 40 ～ 50세, 50세 이상)에서는 39세 이하에서 심사기준 적용 전에 비해서 적용 후에 환자당 총약제비가 월등한 감소폭을 보였다. 1년 미만의 개원기간이 짧은 경우 심사기준 적용 전에 비하여 적용 후에 환자당 총약제비가 높은 감소폭을 보였으며, 1년 미만과 1년 이상의 개원기간 간에 통계적으로 유의한 차이를 보였다. 소재지역에서는 중소도시가 대도시 보다 심사기준 적용 전에 비해서 적용 후에 환자당 총약제비가 월등한 감소폭을 보였으나, 대도시와 중소도시 간에 통계적으로 유의한 차이는 없었다

둘째, 내원일당 약제비는 의사의 연령, 표시과목, 개원기간에 따른 처방행태의 변화가 통계적으로 유의한 차이를 보였다. 표시과목이 내과와 일반의에서는 심사기준 적용 전에 비하여 적용 후에 환자당 총약제비가 감소되었다.

셋째, 환자당 총약품목수는 심사기준 적용 전에 비해서 적용 후에 대체적으로 감소되었다. 아울러 개원기간에 따른 처방행태 변화가 통계적으로 유의한 차이를 보였다. 따라서 3개의 종속변수(환자당 총약제비, 내원일당 약제비, 환자당 총약품목수) 모두에서 개원기간에 따른 처방행태 변화가 모두 통계적으로 유의한 차이를 보였으며, 2개의 종속변수(환자당 총약제비, 내원일당 약제비)에서 표시과목에 따른 변화가 통계적으로 유의한 차이를 보였다.

심사기준 적용의 효과를 분석한 본 연구는 두가지 관점에서 해석할 수 있다 첫째는 분석결과에서 심사기준 적용은 의약품의 비용절감 측면과 의약품 처방행태 변화가 있는 것으로 파악되었다. 둘째는 의사 및 요양기관의 특성별로 심사기준 적용에 따라 처방행태가 민감하게 나타나는 군과 그렇지 않은 군의 차이가 확실히 있었음을 보여주었다.

[영문]This study aimed to closely investigate changes in physician''s behavior after medical fees review standards application that use as a medical review tool in Health Care Agency of Medical Fees Review Organization and to study through changes analysis of prescribing behavior in drug for digestive organ system.

Because of in this study analysis unit is physician, I aimed to analysis to revision on the patient''s characteristics. So, the data of this study was medical fees claim''s data of all May and July 2002 before and after medical fees review standards application about drug for digestive organ system that was disease of gastric ulcer(K25) or duodenal ulcer(K26). And the data was except 2 more physician and operation patient among in health insurance medical care clinic and was selected health insurance medical care clinic''s medical fees claim''s data that was 5 more patient as outpatient that was prescribed all May and July 2002. Therefore, the count of 183 medical care clinic was selected and analysis''s result is described.

1. The results of changes in prescribing behavior after medical fees review standards application were as follows :

First, the drug expenses per patient was decreased after than before medical fees review standards application but the result was not statistically significance.

Second, the drug expenses per visiting clinic was increased after than before medical fees review standards application but difference of before and after was not statistically significance. But, the number days of visiting clinic was decreased after medical fees review standards application

Third, the counts of drug per patient was decreased after than before medical fees review standards application but the result was statistically significance.

2. The results of changes in prescribing behavior of particular physician and

or health insurance medical care clinic characteristics after medical fees review standards application were as follows :

First, the drug expenses per patient was decreased after than before medical fees review standards application but the result was statistically significance in prescribing behavior''s changes according to expression of speciality(medicine, family medicine, general physician) and opening duration of an institution(less than 1 year, 1 year or more). In less than 39 years old physicians among in physician''s age(less than 39 years old, 40～50 years old, 50 years old or more), the drug expenses per patient was markedly decreased after than before medical fees review standards application. In short opening duration of an institution(less than 1 year), the drug expenses per patient was markedly decreased after than before medical fees review standards application. And either less than 1 year or 1 year or more opening duration of an institution, the result was statistically significance. In a small and medium city''s clinic region, the drug expenses per patient was markedly decreased after than before medical fees review standards application. But either a big city or a small and medium city''s clinic region, the result was not statistically significance.

Second, the drug expenses per visiting clinic was statistically significant difference of prescribing behavior''s change according to physician''s age and expression of speciality and opening duration of an institution. In medicine and general physician of expression of speciality, the drug expenses per patient was decreased after than before medical fees review standards application.

Third, the counts of drug per patient was generally decreased after than before medical fees review standards application. And was statistically significant difference of prescribing behavior''s change according to opening duration of an institution. Therefore the result was statistically significant difference of prescribing behavior''s change according to opening duration of an institution. in three dependent variables(drug expenses per patient, drug expenses per visiting clinic, counts of drug per patient), and was statistically significant difference of prescribing behavior''s change according to expression of speciality in two dependent variables(drug expenses per patient, drug expenses per visiting clinic).

This study is analysis of medical fees review standard''s effect. The result of this study was comprehended in two point of view.

First, medical fees review standards application was a point of view in health care insurance cost economy of drugs and a point of view in prescribing behavior''s change.

Second, the result of this study was known that prescribing behavior''s significant change groups and not-significant groups was divided according to medical fees review standards application in particular physician and

or health insurance medical care clinic.