Drug Utilization Review

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

Featured in half-yearly report: G-politik in Industrieländern 11

Abstract

Facing quality problems in the use of drugs, due to the prescriptions that contain drugs that should not be used simultaneously or should not be used by those under a certain age, the Ministry of Health and Welfare decided to mandate physicians to use a software that reviews and detects the above type of inadequate prescriptions. Although physicians are opposed to the new policy on drug utilization review, it is expected to improve the quality of drug utilization.

Purpose of health policy or idea

To improve quality in the use of pharmaceuticals, the Ministry of Health and Welfare decided to mandate physicians and pharmacisits to use a software that reviews and detects inadequate prescriptions of drugs that should not be taken together or drugs that should not be prescribed for those under a certain age. The software informs the physicians or pharmacists of the above type of mistakes at the point of prescription (or dispensing). If the doctor ignores the warning and gives the prscription, the software it informs the patient and the Health Insurance Review Agency (HIRA) (on real time base) of the inadequate prescription.

Main points

Main objectives

To improve the quality in the utilization of pharmaceuticals by detecting the errors in physician prescription. 

Type of incentives

Medical doctors who do not use the software won't get their insurance claims reimbursed.

Groups affected

Patients/Consumers, Medical providers

Innovationsgrad	traditionell		innovativ
Kontroversität	unumstritten		kontrovers
Strukturelle Wirkung	marginal		fundamental
Medienpräsenz	sehr gering		sehr hoch
Übertragbarkeit	sehr systemabhängig		systemneutral

Political and economic background

The Ministry of Health and Welfare previously made a list of drugs that should not be used together (combined utilization) or that should not be prescribed for those under a certain age. Although the information on the above list had been provided to physicians and pharmacists in January 2004, many doctors still have not changed their prescription behavior, resulting in about 20,000 cases with the above type inadequate prescription per year. 

Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Origins of health policy idea

In the past, when HIRA detected inadequate prescriptions in the process of claim review for reimbursing physicians, it informed the patients of the problematic prescription. But it was often too late because the patients had already taken the medicines as prescribed. Therefore, the MInistry of Health and Welfare concluded that patient and insurer need to be informed of the inadequate prescription on a real time basis.

Initiators of idea/main actors

• Regierung

Approach of idea

The approach of the idea is described as:
new:

Stakeholder positions

Medical providers (Korean Medical Association) have been strongly opposed to the new policy of drug utilization review. They maintain that the new policy is a unfair limit on the autonomy of the doctor's prescription. They are worried that the software will be extended to enforce a policy to further restrict the prescription of doctors in the near future.

Actors and positions

Regierung
Ministry of Health and Welfare	sehr unterstützend		stark dagegen
Health Insurance Review Agency	sehr unterstützend		stark dagegen
Korean Medical Association	sehr unterstützend		stark dagegen

Actors and influence

Regierung
Ministry of Health and Welfare	sehr groß		kein
Health Insurance Review Agency	sehr groß		kein
Korean Medical Association	sehr groß		kein

Positions and Influences at a glance

Adoption and implementation

The strong opposition of doctors is not likely to get public support, since the new policy is based on scientific evidence about the side effects of some medicines when they are used together or when they are used for some age groups.

If medical providers do not use the new software their insurance claims will be returned and doctors cannot get reimbursement. So doctors are likely to conform to the new policy soon. The Ministry of Health and Welfare needs to actively disseminate information on the benefits of the new policy to patients/consumers.

Expected outcome

The new policy on drug utilization review is expected to reduce the side effects in the use of drugs due to the inadequate prescription of drugs that should not be combined or that should not be used for those under a certain age. Drug utilization review will therefore contribute to improving the quality of drug utilization for patients.

Impact of this policy

Qualität	kaum Einfluss		starker Einfluss
Gerechtigkeit	System weniger gerecht		System gerechter
Kosteneffizienz	sehr gering		sehr hoch

References

Author/s and/or contributors to this survey

Kwon, Soonman

Empfohlene Zitierweise für diesen Online-Artikel:

Kwon, Soonman. "Drug Utilization Review". Health Policy Monitor, April 2008. Available at http://www.hpm.org/survey/rok/a11/3