[헬스코리아뉴스 / 박민주] According to the Rules on the Standards for Medical Care Benefit of the National Health Insurance (Article 1-2), the Minister of Health and Welfare must provide medical feasibility, medical significance, clinical usefulness such as treatment effectiveness, cost effectiveness, patient cost burden, and social benefits. and health insurance financial situation, etc. to determine whether or not to be eligible for medical care benefits. When designated as a benefit item, the patient receives a significant portion of the medical expenses from the health insurance finance.
On the other hand, patients are more dissatisfied with expensive drugs because the patient pays the full cost for non-covered drugs. We looked at the current salary standards and what the problem was three times. [편집자 주]
Osteoporosis, the urgent need to improve the treatment continuity … The problem is the salary standard
In 2025, Korea will enter a super-aged society in which 20% of the total population is composed of the elderly. This rate is expected to accelerate even further, reaching 25% in 2030 and 44% in 2050. An increase in the elderly population leads to an increase in the number of chronic disease patients.
However, the reimbursement standards for osteoporosis, which are defined as chronic diseases in international guidelines, are too strict, unlike other chronic diseases such as diabetes or high blood pressure, and some of them present standards that contradict international guidelines.
According to two expert perception surveys (in 2014 and 2019) conducted by the Korean Society of Bone Metabolism, many opinions were that the insurance benefit standards for osteoporosis drugs were too restrictive compared to other chronic diseases such as hypertension and diabetes. It was pointed out that improving the continuity of osteoporosis treatment is the most urgent task.
It is important for osteoporosis patients to increase the bone density to a state where there is no risk of fracture and maintain it through drug treatment that prevents bone loss of weakened bones or promotes bone formation. However, it is pointed out that the current salary standards do not reflect this.
Osteoporosis is a major treatment bone resorption inhibitorWow osteogenesis-promoting agentis divided into
priority bone resorption inhibitorAccording to the salary standards of In the case of fracture patients, benefits can be applied for only 3 years. Even that, if the bone density exceeds -2.5 during treatment, the benefit will be stopped. This means that the patient has no choice but to stop taking the drug during treatment.
In this way, it is known that Korea is the only country that limits the period of treatment for bone resorption inhibitors based on bone density. In the drug reimbursement standard, the starting point of treatment (bone density -2.5) and the end point of treatment drug payment (bone density -2.5) are the same, and it is a situation that needs improvement.
International guidelines, such as the American Society of Clinical Endocrinology (AACE), define osteoporosis as a chronic disease that must be managed consistently, while the domestic reimbursement standards are for stopping benefits depending on the patient’s improvement. Experts explain that if a patient’s treatment is stopped due to the discontinuation of benefits, osteoporosis may worsen again.
osteogenesis-promoting agentuses bone resorption inhibitors for one year first, and then applies the benefit if another fracture occurs. On the other hand, the latest international guidelines, such as AACE and the Endocrine Society, recommend a treatment to maintain bone density by first using a bone formation promoter as an initial treatment to increase bone density, and then administering a bone resorption inhibitor.
According to the Korean Society of Bone Metabolism, several clinical literatures have shown that when a bone resorption inhibitor is administered first and then converted to a bone formation promoter, the effect of increasing bone density is slowed compared to when a bone formation promoter is first administered to a patient who has not previously taken the drug. is being reported
The method of administering a bone resorption inhibitor after the use of a bone formation accelerator suggested by the international medical guidelines is a strategy to generate bone components by administering the bone formation promoter to rapidly increase bone density, and then maintain the therapeutic effect through the bone resorption inhibitor. to be.
As such, it is pointed out that improvement is needed because there are reports that domestic reimbursement standards are the opposite of international guidelines, and there are reports that the domestic reimbursement method slows the treatment effect of patients.
Korean Society of Bone Metabolism Delivers Policy Proposals to the National Assembly … Calls for Active Treatment
The Korean Society of Bone Metabolism has recently delivered policy proposals to Kim Min-seok, chairman of the National Assembly’s Health and Welfare Committee, Min-seok Kim of the National Assembly Health and Welfare Committee, and Rep. Kang Ki-yoon, secretary of the People’s Power of the Welfare Committee, urging the government to actively improve the salary standards.
In their policy proposal, they pointed out that “even though the purpose of osteoporosis treatment is to prevent fractures, the current osteoporosis drug reimbursement standards limit the period of drug administration, so there are policy limitations in preventing fractures through continuous treatment.” Therefore, he emphasized the need to ensure the continuous administration of bone resorption inhibitors so that osteoporosis patients can continuously maintain and strengthen their bone density, which has been increased through drug treatment.
It was also pointed out that, in the case of the ‘ultra-high-risk group for fractures’ who have recently suffered a fracture or have had multiple fractures, the current reimbursement standards do not meet the goal of preventing fractures, even though strong osteoporosis treatment is required.
The society said, “In order to prevent re-fracture in the very high fracture risk group, the reimbursement standards for bone formation promoters should be improved. ” he asserted.
In addition, he emphasized the necessity of △promoting osteoporosis disease awareness improvement projects △reinforcing osteoporosis screening and follow-up management within the national health checkup △Korean-style re-fracture prevention service pilot project △establishing a five-year comprehensive plan for fracture and osteoporosis disease management.
However, it is unclear whether these efforts will lead to improvement in the salary standard. In a recent phone call with Health Korea News, an official of the Korean Bone Metabolism Society expressed his frustration by saying, “The policy proposals were delivered at the end of last month and early this month, but there is no response yet.” This is a point that shows the reality that improving the salary standard is not as easy as it sounds.
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