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An Overview of the Risk Sharing Management in Korean National Health Insurance, Focused on the Effect of the Patient Access and Insurance Finance
Korean J Clin Pharm 2018;28(2):124-130
Published online June 30, 2018
© 2018 Korean College of Clinical Pharmacy.

Jong Hyuk Lee1* and Joon Seok Bang2*

1Department of Pharmaceutical Engineering, College of Life and Health Science, Hoseo University, Asan 31499, Republic of Korea
2Graduate School of Clinical Pharmacy, Sookmyung Women’s University, Seoul 04310, Republic of Korea
Correspondence to: * Joon Seok Bang, Graduate School of Clinical Pharmacy, Sookmyung Women’s University, Cheongpa-ro 47-gil, Seoul 04310, Republic of Korea
Tel: +82-2-2077-7526, Fax: +82-2-710-9799 E-mail: jsbang@sookmyung.ac.kr
Co-Correspondence to: * Jong Hyuk Lee, Department of Pharmaceutical Engineering, College of Life and Health Sciences, Hoseo University, 20 Hoseo-ro 79, Baebang-eup, Asan 31499, Republic of Korea
Tel: +82-41-540-9814, Fax: +82-41-540-9538 E-mail: jhyuk@hoseo.edu
Received April 18, 2018; Revised June 18, 2018; Accepted June 18, 2018.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Objective: This study examined the Risk Sharing Agreement (RSA) on pharmaceutical pricing system in Korean national health insurance. Through RSA, the insurer was able to maintain the principles in the price listing process while managing the budget effectively and improving patient access to new drugs. Despite these positive effects, there are still issues raised by some stakeholders, such as lack of transparency in the listing process and doubts about its effectiveness. Therefore, we investigated the impacts of RSA on national health insurance financing and patient access to analyze the effects of RSA.
Methods: The impact of RSA was investigated by analyzing the health insurance claims data for 2014∼2016. The degree of improvement in patient access was determined by the decreased amount of patients’ payment.
Results: Results showed that the financial impact of RSA was not significant and patients’ access to the new drug greatly improved.
Conclusion: These results show that RSA is a good system for improving patient access to new drugs without additional expense on insurance.
Keywords : Risk sharing agreement, pharmaceutical pricing, patient access, insurance finance, national health insurance


June 2018, 28 (2)
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