Skip to main content
Top
Published in: BMC Health Services Research 1/2018

Open Access 01-12-2018 | Research article

Effects of a price cut reform on the cost and utilization of antidiabetic drugs in Korea: a national health insurance database study

Authors: Hae Sun Suh, Jee-Ae Kim, Iyn-Hyang Lee

Published in: BMC Health Services Research | Issue 1/2018

Login to get access

Abstract

Background

Despite the potential widespread application and a significant need, the policy effectiveness of prescribed medications price controls has not been studied extensively. We aimed to explore the effects of a price cut introduced in April 1st of 2012 on the cost and utilization of antidiabetics in South Korea.

Methods

We identified approximately four million outpatients who filed at least one diabetes-related claim during the index period (January 2010 to December 2012) using the National Health Insurance claims data. We performed interrupted time series analyses for cost and utilization of “overall,” “reduced price,” and “constant price” antidiabetics between January 2009 and June 2013, and measured the growth rate for incidents of medical and surgical procedures for diabetes-induced complications.

Results

The segmented regression suggests that spending on overall and reduced price antidiabetics would drop by 6 and 23%, respectively; spending on constant price antidiabetics would rise by 16% in a year after the new pricing compared to if the policy were not in existence. There were a few immediate changes in utilization, and its trend indicated a significant decrease in reduced price antidiabetics and an increase in constant price antidiabetics. Incidents of medical and surgical procedures relating to diabetic complications were unaffected.

Conclusions

The Korean price cut program contained costs by immediately reducing the cost of pharmaceuticals without any major signals associated with compromised clinical conditions in diabetic patients.
Literature
1.
go back to reference Guillen AM, Cabiedes L. Reforming pharmaceutical policies in the European Union: a “penguin effect”? Int J Health Serv. 2003;33(1):1–28.CrossRefPubMed Guillen AM, Cabiedes L. Reforming pharmaceutical policies in the European Union: a “penguin effect”? Int J Health Serv. 2003;33(1):1–28.CrossRefPubMed
2.
go back to reference Mossialos E, Mrazek M, Walley T. Regulating pharmaceuticals in Europe: striving for efficiency, equity and quality. Maidenhead: Open University Press; 2004. Mossialos E, Mrazek M, Walley T. Regulating pharmaceuticals in Europe: striving for efficiency, equity and quality. Maidenhead: Open University Press; 2004.
3.
go back to reference OECD: Pharmaceutical pricing policies in a global market. Paris: OECD (Organisation for Economic Co-operation and Development); 2008. OECD: Pharmaceutical pricing policies in a global market. Paris: OECD (Organisation for Economic Co-operation and Development); 2008.
4.
go back to reference Traulsen JM, Almarsdottir AB. The argument for pharmaceutical policy. Pharm World Sci. 2005;27(1):7–12.CrossRefPubMed Traulsen JM, Almarsdottir AB. The argument for pharmaceutical policy. Pharm World Sci. 2005;27(1):7–12.CrossRefPubMed
5.
go back to reference Maynard A, Bloor K. Dilemmas in regulation of the market for pharmaceuticals. Health Aff (Millwood). 2003;22(3):31–41.CrossRef Maynard A, Bloor K. Dilemmas in regulation of the market for pharmaceuticals. Health Aff (Millwood). 2003;22(3):31–41.CrossRef
6.
go back to reference Gray JAM. Doing the right things right. In: Evidence-based healthcare: how to make health policy and management decisions. 2nd ed. London: Harcourt Publishers Limited; 2001. p. 37–64. Gray JAM. Doing the right things right. In: Evidence-based healthcare: how to make health policy and management decisions. 2nd ed. London: Harcourt Publishers Limited; 2001. p. 37–64.
7.
go back to reference Daniels N, Sabin J. The ethics of accountability in managed care reform. Health Affair. 1998;17(5):50–64.CrossRef Daniels N, Sabin J. The ethics of accountability in managed care reform. Health Affair. 1998;17(5):50–64.CrossRef
8.
go back to reference Wharam JF, Daniels N. Toward evidence-based policy making and standardized assessment of health policy reform. JAMA. 2007;298(6):676–9.CrossRefPubMed Wharam JF, Daniels N. Toward evidence-based policy making and standardized assessment of health policy reform. JAMA. 2007;298(6):676–9.CrossRefPubMed
9.
go back to reference Aaserud M, Dahlgren AT, Sturm H, Kosters JP, Hill S, Furberg CD, Grilli R, Henry DA, Oxman AD, Ramsay C, et al. Pharmaceutical policies: effects on rational drug use, an overview of 13 reviews. (Protocol). Cochrane Db Syst Rev. 2006;(2):CD004397. Aaserud M, Dahlgren AT, Sturm H, Kosters JP, Hill S, Furberg CD, Grilli R, Henry DA, Oxman AD, Ramsay C, et al. Pharmaceutical policies: effects on rational drug use, an overview of 13 reviews. (Protocol). Cochrane Db Syst Rev. 2006;(2):CD004397.
10.
go back to reference Austvoll-Dahlgren A, Aaserud M, Vist G, Ramsay C, Oxman AD, Sturm H, Kosters JP, Vernby A. Pharmaceutical policies: effects of cap and co-payment on rational drug use. Cochrane Db Syst Rev. 2008;1:CD007017. Austvoll-Dahlgren A, Aaserud M, Vist G, Ramsay C, Oxman AD, Sturm H, Kosters JP, Vernby A. Pharmaceutical policies: effects of cap and co-payment on rational drug use. Cochrane Db Syst Rev. 2008;1:CD007017.
11.
go back to reference Green CJ, Maclure M, Fortin PM, Ramsay CR, Aaserud M, Bardal S. Pharmaceutical policies: effects of restrictions on reimbursement. Cochrane Db Syst Rev. 2010;8:CD008654. Green CJ, Maclure M, Fortin PM, Ramsay CR, Aaserud M, Bardal S. Pharmaceutical policies: effects of restrictions on reimbursement. Cochrane Db Syst Rev. 2010;8:CD008654.
12.
go back to reference Jacobzone S. Pharmaceutical policies in OECD countries: reconciling social and industrial goals. Paris: Organisation for Economic Co-operation and Development; 2000.CrossRef Jacobzone S. Pharmaceutical policies in OECD countries: reconciling social and industrial goals. Paris: Organisation for Economic Co-operation and Development; 2000.CrossRef
13.
go back to reference Mrazek MF. Comparative approaches to pharmaceutical price regulation in the European Union. Croat Med J. 2002;43(4):453–61.PubMed Mrazek MF. Comparative approaches to pharmaceutical price regulation in the European Union. Croat Med J. 2002;43(4):453–61.PubMed
14.
go back to reference Mrazek M, Mossialos E, editors. Regulating pharmaceutical prices in the European Union. Maidenhead: Open University Press; 2004. Mrazek M, Mossialos E, editors. Regulating pharmaceutical prices in the European Union. Maidenhead: Open University Press; 2004.
15.
go back to reference Lee I-H, Bloor K, Hewitt C, Maynard A. International experience in controlling pharmaceutical expenditure: influencing patients and providers and regulating industry - a systematic review. J Health Serv Res Policy. 2015;20(1):52–9.CrossRefPubMedPubMedCentral Lee I-H, Bloor K, Hewitt C, Maynard A. International experience in controlling pharmaceutical expenditure: influencing patients and providers and regulating industry - a systematic review. J Health Serv Res Policy. 2015;20(1):52–9.CrossRefPubMedPubMedCentral
16.
go back to reference Thomson S, Mossialos E. Influencing demand for durgs through cost sharing. In: Mossialos E, Mrazek M, Walley T, editors. Regulating pharmaceuticals in Europe: striving for efficiency, equity and quality. Maidenhead: Open University Press; 2004. p. 227–44. Thomson S, Mossialos E. Influencing demand for durgs through cost sharing. In: Mossialos E, Mrazek M, Walley T, editors. Regulating pharmaceuticals in Europe: striving for efficiency, equity and quality. Maidenhead: Open University Press; 2004. p. 227–44.
17.
go back to reference Soumerai SB, Ross-Degnan D, Avorn J, Tj ML, Choodnovskiy I. Effects of Medicaid drug-payment limits on admission to hospitals and nursing homes. New Engl J Med. 1991;325(15):1072–7.CrossRefPubMed Soumerai SB, Ross-Degnan D, Avorn J, Tj ML, Choodnovskiy I. Effects of Medicaid drug-payment limits on admission to hospitals and nursing homes. New Engl J Med. 1991;325(15):1072–7.CrossRefPubMed
18.
go back to reference Tamblyn R, Laprise R, Hanley JA, Abrahamowicz M, Scott S, Mayo N, Hurley J, Grad R, Latimer E, Perreault R, et al. Adverse events associated with prescription drug cost-sharing among poor and elderly persons. JAMA. 2001;285(4):421–9.CrossRefPubMed Tamblyn R, Laprise R, Hanley JA, Abrahamowicz M, Scott S, Mayo N, Hurley J, Grad R, Latimer E, Perreault R, et al. Adverse events associated with prescription drug cost-sharing among poor and elderly persons. JAMA. 2001;285(4):421–9.CrossRefPubMed
19.
go back to reference Soumerai SB, McLaughlin TJ, Ross-Degnan D, Casteris CS, Bollini P. Effects of a limit on Medicaid drug-reimbursement benefits on the use of psychotropic agents and acute mental health services by patients with schizophrenia. New Engl J Med. 1994;331(10):650–5.CrossRefPubMed Soumerai SB, McLaughlin TJ, Ross-Degnan D, Casteris CS, Bollini P. Effects of a limit on Medicaid drug-reimbursement benefits on the use of psychotropic agents and acute mental health services by patients with schizophrenia. New Engl J Med. 1994;331(10):650–5.CrossRefPubMed
20.
go back to reference Roblin DW, Platt R, Goodman MJ, Hsu J, Nelson WW, Smith DH, Andrade SE, Soumerai SB. Effect of increased cost-sharing on oral hypoglycemic use in five managed care organizations: how much is too much? Med Care. 2005;43(10):951–9.CrossRefPubMed Roblin DW, Platt R, Goodman MJ, Hsu J, Nelson WW, Smith DH, Andrade SE, Soumerai SB. Effect of increased cost-sharing on oral hypoglycemic use in five managed care organizations: how much is too much? Med Care. 2005;43(10):951–9.CrossRefPubMed
21.
go back to reference Bloor K, Maynard A. International pharmaceutical policy: health creation or wealth creation? In: Freemantle N, Hill S, editors. Evaluating Pharmaceuticals for Health Policy and Reimbursement. London: BMJ; 2004. Bloor K, Maynard A. International pharmaceutical policy: health creation or wealth creation? In: Freemantle N, Hill S, editors. Evaluating Pharmaceuticals for Health Policy and Reimbursement. London: BMJ; 2004.
22.
go back to reference Coulton L, Annemans L, Javier J, Brown R, Keskinaslan A: Risk-sharing schemes worldwide: A landscape analysis of health outcomes-based reimbursement agreements International Society for Pharmacoeconomics and Outcomes Research. Phuket; 2010. Coulton L, Annemans L, Javier J, Brown R, Keskinaslan A: Risk-sharing schemes worldwide: A landscape analysis of health outcomes-based reimbursement agreements International Society for Pharmacoeconomics and Outcomes Research. Phuket; 2010.
23.
go back to reference Adamski J, Godman B, Ofierska-Sujkowska G, Osinska B, Herholz H, Wendykowska K, Laius O, Jan S, Sermet C, Zara C, et al. Risk sharing arrangements for pharmaceuticals: potential considerations and recommendations for European payers. BMC Health Serv Res. 2010;10:153.CrossRefPubMedPubMedCentral Adamski J, Godman B, Ofierska-Sujkowska G, Osinska B, Herholz H, Wendykowska K, Laius O, Jan S, Sermet C, Zara C, et al. Risk sharing arrangements for pharmaceuticals: potential considerations and recommendations for European payers. BMC Health Serv Res. 2010;10:153.CrossRefPubMedPubMedCentral
24.
go back to reference Wertheimer AI, Huang M-Y. The healthcare system and pharmceutical prices in United States. In: Barbar Z-U-D, editor. Pharmaceutical prices in the 21st century. Switzerland: Springer International Publishing; 2015. p. 309–19. Wertheimer AI, Huang M-Y. The healthcare system and pharmceutical prices in United States. In: Barbar Z-U-D, editor. Pharmaceutical prices in the 21st century. Switzerland: Springer International Publishing; 2015. p. 309–19.
25.
go back to reference Aaserud M, Dahlgren AT, Kosters JP, Oxman AD, Ramsay C, Sturm H. Pharmaceutical policies: effects of reference pricing, other pricing, and purchasing policies. Cochrane Db Syst Rev. 2006;2:CD005979. Aaserud M, Dahlgren AT, Kosters JP, Oxman AD, Ramsay C, Sturm H. Pharmaceutical policies: effects of reference pricing, other pricing, and purchasing policies. Cochrane Db Syst Rev. 2006;2:CD005979.
26.
go back to reference Acosta A, Ciapponi A, Aaserud M, Vietto V, Austvoll-Dahlgren A, Kosters JP, Vacca C, Machado M, Diaz Ayala DH, Oxman AD. Pharmaceutical policies: effects of reference pricing, other pricing, and purchasing policies. Cochrane Db Syst Rev. 2014;(10):CD005979. Acosta A, Ciapponi A, Aaserud M, Vietto V, Austvoll-Dahlgren A, Kosters JP, Vacca C, Machado M, Diaz Ayala DH, Oxman AD. Pharmaceutical policies: effects of reference pricing, other pricing, and purchasing policies. Cochrane Db Syst Rev. 2014;(10):CD005979.
27.
go back to reference Lee I-H, Bloor K. Pharmaceutical pricing policies in South Korea. In: Babar Z-U-D, editor. Pharmaceutical prices in the 21st century. Switzerland: Springer International Publishing; 2015. p. 151–69. Lee I-H, Bloor K. Pharmaceutical pricing policies in South Korea. In: Babar Z-U-D, editor. Pharmaceutical prices in the 21st century. Switzerland: Springer International Publishing; 2015. p. 151–69.
28.
go back to reference NHIS, HIRA. National Health Insurance statistical yearbook 2013. National Health Insurance Service, Health Insurance Review & Assessment: Seoul; 2014. NHIS, HIRA. National Health Insurance statistical yearbook 2013. National Health Insurance Service, Health Insurance Review & Assessment: Seoul; 2014.
30.
go back to reference Health Insurance Review & Assessment Service. WHO ATC classification for prescription medications. Seoul: Health Insurance Review & Assessment Service; 2007. Health Insurance Review & Assessment Service. WHO ATC classification for prescription medications. Seoul: Health Insurance Review & Assessment Service; 2007.
31.
go back to reference Wagner AK, Soumerai SB, Zhang F, Ross-Degnan D. Segmented regression analysis of interrupted time series studies in medication use research. J Clin Pharm Ther. 2002;27(4):299–309.CrossRefPubMed Wagner AK, Soumerai SB, Zhang F, Ross-Degnan D. Segmented regression analysis of interrupted time series studies in medication use research. J Clin Pharm Ther. 2002;27(4):299–309.CrossRefPubMed
32.
go back to reference Ostrom CWJ. Time series regression analysis: nonlagged case. In: Time series analysis: regression techniques. 2nd ed. London: SAGE Publications, Inc.; 1990. p. 7–42.CrossRef Ostrom CWJ. Time series regression analysis: nonlagged case. In: Time series analysis: regression techniques. 2nd ed. London: SAGE Publications, Inc.; 1990. p. 7–42.CrossRef
33.
go back to reference Gujarati DN, Porter DC. Econometric modeling: model specification and diagnostic testing. In: Basic econometrics. Singapore: McGraw Hill; 2009. p. 467–522. Gujarati DN, Porter DC. Econometric modeling: model specification and diagnostic testing. In: Basic econometrics. Singapore: McGraw Hill; 2009. p. 467–522.
34.
go back to reference Social Pharmacy Committee in Korean Association of Pharmacy Education: Pharmaceuticals and National Health Insurance. In: Administrative and managerial pharmacy. Edited by Social Pharmacy Committee in Korean Association of Pharmacy Education. Seoul: PanMun Education; 2013. p. 107–145. Social Pharmacy Committee in Korean Association of Pharmacy Education: Pharmaceuticals and National Health Insurance. In: Administrative and managerial pharmacy. Edited by Social Pharmacy Committee in Korean Association of Pharmacy Education. Seoul: PanMun Education; 2013. p. 107–145.
35.
go back to reference Kwon H-Y, Hong J-M, Godman B, Yang B-M. Price cuts and drug spending in South Korea: the case of antihyperlipidemic agents. Health Policy. 2013;112(3):217–26.CrossRefPubMed Kwon H-Y, Hong J-M, Godman B, Yang B-M. Price cuts and drug spending in South Korea: the case of antihyperlipidemic agents. Health Policy. 2013;112(3):217–26.CrossRefPubMed
36.
go back to reference Han E, Chae SM, Kim NS, Park S. Effects of pharmaceutical cost containment policies on doctors’ prescribing behavior: focus on antibiotics. Health Policy. 2015;119(9):1245–54.CrossRefPubMed Han E, Chae SM, Kim NS, Park S. Effects of pharmaceutical cost containment policies on doctors’ prescribing behavior: focus on antibiotics. Health Policy. 2015;119(9):1245–54.CrossRefPubMed
37.
go back to reference Yoo KB, Lee SG, Park S, Kim TH, Ahn J, Cho MH, Park EC. Effects of drug price reduction and prescribing restrictions on expenditures and utilisation of antihypertensive drugs in Korea. BMJ Open. 2015;5(7):2014–006940.CrossRef Yoo KB, Lee SG, Park S, Kim TH, Ahn J, Cho MH, Park EC. Effects of drug price reduction and prescribing restrictions on expenditures and utilisation of antihypertensive drugs in Korea. BMJ Open. 2015;5(7):2014–006940.CrossRef
38.
go back to reference Hsu JC, Lu CY, Wagner AK, Chan KA, Lai MS, Ross-Degnan D. Impacts of drug reimbursement reductions on utilization and expenditures of oral antidiabetic medications in Taiwan: an interrupted time series study. Health Policy. 2014;116(2–3):196–205.CrossRefPubMed Hsu JC, Lu CY, Wagner AK, Chan KA, Lai MS, Ross-Degnan D. Impacts of drug reimbursement reductions on utilization and expenditures of oral antidiabetic medications in Taiwan: an interrupted time series study. Health Policy. 2014;116(2–3):196–205.CrossRefPubMed
39.
go back to reference Korean Diabetes Association. Diabetes fact sheet in Korea, vol. 2012. Seoul: Korean Diabetes Association, Korea Centers for Disease Control and Prevention. Korean Diabetes Association. Diabetes fact sheet in Korea, vol. 2012. Seoul: Korean Diabetes Association, Korea Centers for Disease Control and Prevention.
Metadata
Title
Effects of a price cut reform on the cost and utilization of antidiabetic drugs in Korea: a national health insurance database study
Authors
Hae Sun Suh
Jee-Ae Kim
Iyn-Hyang Lee
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2018
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-018-3255-y

Other articles of this Issue 1/2018

BMC Health Services Research 1/2018 Go to the issue