OBJECTIVE: To evaluate the relative benefits and the costs associated with the introduction of the new pharmaceutical provision called 'Mandatory Prescription Syste m' which separates the role of physicians from that of pharmacists with respect to the prescription and dispensation of from the perspective of consumers (i.e., patients). METHODS: The costs of the system were measured by considering both direct and indirect costs. Direct costs included additional payments for ambulatory care and dispensing fees that occurred under the new system. Indirect costs consisted of transportation expenses and costs related to time spent for physician consultation, waiting for the prescriptions to be filled, and extra traveling. Benefits identified in this study were the reduction of drug misuse and overuse, and the overall decrease in drug consumption among the Korean population. Sensitivity analysis was performed for the inclusion of benefits for outpatients of hospitals, price elasticity, and increased fees for established patients. RESULTS: The net benefit was estimated to be about minus 1,862 billion won and the benefit-cost ratio was 0.478. This indicates that the costs of 'Mandatory Prescription' outweigh its benefits, relative to the previous system. The sensitivity analysis results for all the variables considered in this study consistently showed the benefit-cost ratio to be less than 1. CONCLUSION: The results of this study suggest that implementing Mandatory Prescription System in Korea might be inefficient from the consumer's perspective. The results of this study do not coincide with the results of previous studies, presumably because of the differences in study design and in which items of costs and benefits were considered.
Ambulatory Care ; Cost-Benefit Analysis* ; Elasticity ; Fees and Charges ; Humans ; Korea* ; Outpatients ; Pharmacists ; Prescription Fees ; Prescriptions* ; Transportation

The separation of pharmaceutical prescription and dispensing has been mandatory in Korea since July 1, 2000. This policy aimed to reduce drug abuse, prevent the distribution of drugs without a prescription, decrease medical costs and insurance premiums, and provide high-quality health-care services. However, the policy was launched without careful consideration of actual benefits to patients or the resulting national financial burden, and its initial aims remain unfulfilled. Koreans have complained that the policy is inconvenient; a 2008 survey revealed that 87% of people would prefer to have their medications dispensed at medical institutes, rather than at pharmacies. People wish to select a convenient dispensing site; the current policy particularly inconveniences disabled and elderly individuals. From 2000 to 2009, dispensing fees totaled 18,432.4 billion Korean won (16.4 billion US dollar), comprising 27% of all pharmaceutical costs. These fees have contributed to the accelerated rise in national health-care expenses (the most rapid in the world) and to the 2.2-fold increase in insurance-premium payments in 2009, in contrast to those in 2000. Pharmaceuticals continue to be dispensed without a physician's prescription and antibiotic abuse has not been controlled. The increasingly prevalent occurrence of multi-drug resistant bacteria constitutes a serious social problem. The Korean government should recognize the difficulties posed by the financial burden of this policy and its failure to achieve a separation between pharmaceutical prescription and dispensing. To improve this policy, we urge the government to undertake a fair and scientific re-evaluation, despite objections by interest groups to such actions.
Academies and Institutes ; Aged ; Bacteria ; Delivery of Health Care ; Fees and Charges ; Humans ; Insurance ; Insurance, Health ; Korea ; Pharmacies ; Prescription Fees ; Prescriptions ; Public Opinion ; Social Problems ; Substance-Related Disorders

The Korean Government has launched a pilot program of the Drug Utilization Review (DUR) system in an effort to facilitate safe and adequate use of pharmaceuticals by providing reference to physicians and pharmacists at the prescription or dispense stage, with regards to the drugs that should not be combined or should not be given to certain age groups. Implementation of the DUR system is absolutely necessary in Korea, as the number of drug taken per patient is on a continuous rise with increase of senior population and development of new pharmaceuticals. The DUR system is expected to contribute to promotion of people's health and reduction of pharmaceutical expense. However, for a successful establishment of the DUR system, the following conditions should be considered: First, inclusion of non-prescription drugs in the system, Second, review on the current classification of non-prescription and prescription drugs, Third, review on therapeutic duplication contraindication, age contraindication, and gravida contraindication by physicians as clinical experts. Moreover, reimbursement within the framework on medical fee schedule for the DUR system should be followed as well as the efforts to adjust problems through open discussion between insurers and providers.
Appointments and Schedules ; Drug Utilization ; Drug Utilization Review ; Fees, Medical ; Humans ; Insurance Carriers ; Korea ; Nonprescription Drugs ; Pharmacists ; Prescription Drugs ; Prescriptions