Korean J Clin Pharm.  2018 Jun;28(2):124-130. 10.24304/kjcp.2018.28.2.124.

An Overview of the Risk Sharing Management in Korean National Health Insurance, Focused on the Effect of the Patient Access and Insurance Finance

• Lee JH
• Bang JS

• KMID: 2416671
• DOI: http://doi.org/10.24304/kjcp.2018.28.2.124

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.

Keyword

Risk sharing agreement; pharmaceutical pricing; patient access; insurance finance; national health insurance

MeSH Terms

Budgets
Humans
Insurance Carriers
Insurance*
Insurance, Health
National Health Programs*