Insurance Budget Research Articles

Impact of Economic Factors on the Process of Population Transition from Labour Activity to Pension in the Republic of Moldova

Abstract The purpose of research is to analyse the impact of population ageing process on labour force market, as well as economic factors on the transition from labour activity to pension in the Republic of Moldova. The change in the structure of labour force to wards elder ages, as well as interruption of active economic activity and retirement is one of the factors in economic growth slowdown, which is conditioned by a reduction of labour force reproduction and its growth. In this situation, in order to mitigate the negative consequences of labour force deficit, it is necessary to take effective measures to increase labour productivity not only to ensure economic growth, but also to ensure the welfare of the country’s population and meet the necessities of an increased share of the population-dependents (both the elderly population and children under 15). Taking into account the relevance of the above-mentioned problem, the analysis of the relationship between economic factors and the transition from labour activity to pension in the conditions of demographic ageing was carried out, including the evaluation of the role of economic factors in making a decision to exit from the labour market to pension. In this context, the comparative quantitative and qualitative analysis of tendencies in the economically active and employed population was carried out, including pre- and pension ages and the phenomenon of precarious employment, the demographic coefficient of dependence on old age, the dependence of pension from the income level, and the financial stability of the Social Insurance Budget. The proposals to improve the effectiveness of government policies in regulation and harmonization the transition from the labour market to pension, including the continuation of active economic activity was elaborated in order to reduce the negative consequences connected with the process of population ageing and to ensure the stability of labour market development. The article is developed in the framework of the research Subprogramme “The demographic transition in the Republic of Moldova: particularities, socioeconomic implications and demographic resilience straightening” (2024-2027).

A proactive financial navigation intervention in patients with newly diagnosed gastric and gastroesophageal junction adenocarcinoma

PurposeMany cancer patients and caregivers experience financial hardship, leading to poor outcomes. Gastric and gastroesophageal junction (GEJ) cancer patients are particularly at risk for financial hardship given the intensity of treatment. This pilot randomized study among gastric/GEJ cancer patients and caregivers tested a proactive financial navigation (FN) intervention to obtain a signal of efficacy to inform a larger, more rigorous randomized study.MethodsWe tested a 3-month proactive FN intervention among gastric/GEJ cancer patients and caregivers compared to usual care. Caregiver participation was optional. The primary endpoint was incidence of financial hardship, defined as follows: accrual of debt, income decline of ≥ 20%, or taking loans to pay for treatment. Data from participant surveys and documentation by partner organizations delivering the FN intervention was analyzed and outcomes were compared between study arms.ResultsNineteen patients and 12 caregivers consented. Primary FN resources provided included insurance navigation, budget planning, and help with out-of-pocket medical expenses. Usual care patients were more likely to experience financial hardship (50% vs 40%) and declines in quality of life (37.5% vs 0%) compared to intervention patients. Caregivers in both arms reported increased financial stress and poorer quality of life over the study period.ConclusionsProactive financial navigation has potentially positive impacts on financial hardship and quality of life for cancer patients and more large-scale randomized interventions should be conducted to rigorously explore the impact of similar interventions. Interventions that have the potential to lessen caregiver financial stress and burden need further exploration.Trial registrationTRN: NCT03986502, June 14, 2019.

Social Infrastructure of Soviet Enterprises in the 1950s-1980s: Sources and Mechanisms of Financing (Example of Chelyabinsk Tractor Plant)

The Sources and Mechanisms of Financing the Social Infrastructure of the Chelyabinsk Tractor Plant in the 1950s-1980s. This study examines the sources and mechanisms of financing the social infrastructure of the Chelyabinsk Tractor Plant, a large Soviet industrial enterprise, during the period of 1950s-1980s. The research is based on archival documents from the plant and its trade union organization, which are stored in the United State Archive of the Chelyabinsk Region. It was found that the plant had a significant amount of assets, including housing and a network of social, cultural, and sports facilities. Financing the social infra-structure of Soviet enterprises was a complex system that involved multiple independent sources. The plant made direct payments from its economic stimulation funds, covered the maintenance costs of various facilities transferred to the trade union organization, and covered losses from the housing and communal services system. In addition, funding for these facilities also came from the state budget, social insurance budget, trade union organization budget, targeted subsidies from the All-Russian Central Council of Trade Unions, revenues from self-supporting cultural and sports institutions, and others. The Chelyabinsk Tractor Plant was required to allocate up to 10 % of its profits towards maintaining its social infra-structure, while other sources of funding con-tributed comparable amounts.

Influence of deprivation on hospital care pathways and costs for people with ischaemic stroke: A trajectory modelling study

BackgroundSocioeconomic characteristics have a strong impact on the incidence of stroke. The highest levels of morbidity and mortality are associated with the lowest socioeconomic positions. Moreover, the health insurance budget for stroke is significant. ObjectivesTo describe typical Hospital Care Pathways (HCPs) and their costs 1 year after acute stroke and to assess the impact of individuals’ socioeconomic characteristics on HCPs and costs. MethodsThis retrospective observational study used hospital data on people with primary ischaemic stroke in a region of France (Haute-Garonne).HCPs were identified by sequential analysis. Multinomial logistic regression was used to analyse the impact of socioeconomic characteristics on HCPs as measured using an ecological index of deprivation, and a gamma regression model was used to analyse costs. ResultsThe analysis identified 4 typical HCPs. The first HCP consisted exclusively of consultations, the second was composed of consultations and hospitalisations, the third included hospitalisations during the first 2 months after stroke followed by consultations, and the fourth included long-term hospitalisations.After adjustment, deprivation was associated with HCPs and determined its costs: a high level of social disadvantage determined the type of pathway and increased the costs. ConclusionsThis study is one of the first to assess the impact of social inequalities in health on post-stroke HCPs in France and their corresponding costs. Our results confirm the hypothesis that healthcare costs differ according to the level of deprivation.

Public health insurance and the risk of cancer-specific mortality in patients with cervical cancer: A Chinese prospective cohort study.

Cervical cancer has one of the highest incidence and mortality rates of any malignant tumor of the female reproductive tract, and its longer treatment period will place significant financial strain on patients and their families. Little is known about how health insurance policies influence cervical cancer prognosis, particularly in developing countries. The relationship between cervical cancer specific death and cervical cancer all-cause mortality with public health insurance, self-payment rate, and the combined effect of public health insurance and self-payment rate was investigated in this study. From 2015 to 2019, a prospective longitudinal cohort study on cervical cancer was carried out in Chongqing, China. We chose 4,465 Chongqing University Cancer Hospital patients who had been diagnosed with cervical cancer between 2015 and 2019. The self-payment rate and public health insurance are taken into account in our subgroup analysis. After applying the inclusion and exclusion criteria, we describe the demographic and clinical traits of patients with various insurance plans and self-payment rates using the chi-square test model. The relationship between cervical cancer patients with various types of insurance, the self-payment rate, and treatment modalities is examined using the multivariate logistic regression model. After applying the inclusion and exclusion criteria, we summarize the demographic and clinical traits of patients with various insurance plans and self-payment rates using the chi-square test model. The association between cervical cancer patients with various types of insurance, the self-payment rate, and treatment modalities is examined using the multivariate logistic regression model. The cumulative hazard ratio of all-cause death and cervical cancer-specific mortality for various insurance types and self-payment rates was then calculated using the Cox proportional hazard model and the competitive risk model. This study included a total of 3,982 cervical cancer patients. During the follow-up period (median 37.3 months, 95% CI: 36.40-38.20), 774 deaths were recorded, with cervical cancer accounting for 327 of them. Patients who obtained urban employee-based basic medical insurance (UEBMI) had a 37.1% lower risk of all-cause death compared to patients who received urban resident-based basic medical insurance (URBMI) (HRs = 0.629, 95% CI: 0.508-0.779, p = 0.001). Patients with a self-payment rate of more than 60% had a 26.9% lower risk of cervical cancer-specific mortality (HRs = 0.731, 95% CI: 0.561-0.952, p <0.02). The National Medical Security Administration should attempt to include the more effective self-paid anti-tumor medications into national medical insurance coverage within the restrictions of restricted medical insurance budget. This has the potential to reduce not only the mortality rate of cervical cancer patients, but also their financial burden. High-risk groups, on the other hand, should promote cervical cancer screening awareness, participate actively in the state-led national cancer screening project and enhance public awareness of HPV vaccine. This has the potential to reduce both cervical cancer patient mortality and the financial burden and impact.

Budget Impact Analysis of Comprehensive Genomic Profiling in Advanced Non–Small Cell Lung Cancer in Taiwan

ObjectivesThe concept of precision oncology using genetic testing has become popular for cancer treatment in recent years. This research aimed to evaluate the financial impact of comprehensive genomic profiling (CGP) in patients with advanced non–small cell lung cancer before receiving any systemic treatments, compared with current practice using single-gene testing, in the hope that the findings can inform the National Health Insurance Administration the decision regarding CGP reimbursement. MethodsA budget impact analysis model was developed comparing the sum of gene testing costs, the first-line and subsequent systemic treatment costs, and other medical costs between the current practice of traditional molecular testing and the new test strategy of CGP. The evaluation time horizon is 5 years from the perspective of the National Health Insurance Administration. Outcome endpoints were incremental budget impact and life-year gained. ResultsThis research indicated CGP reimbursement would benefit 1072 to 1318 more patients receiving target therapies than the current practice and consequently had incremental 232 to 1844 life-years gained from 2022 to 2026. The new test strategy also led to higher gene testing cost and systemic treatment cost. Nevertheless, less medical resource utilization and better patient outcome were demonstrated. The incremental budget impact ranged from US dollar 19 to US dollar 27 million in the 5-year period. ConclusionThis research shows that CGP could pave the way for personalized healthcare with moderate increase of National Health Insurance budget.

COMPARATIVE ASPECTS IN FINANCING OF SOCIAL INSURANCE BENEFITS IN ROMANIA AND THE REPUBLIC OF MOLDOVA

The purpose of the article is to present some aspects of the public social security system in Romania and the Republic of Moldova, starting from the premise that each country has its own mechanism of operation of the economy, which depends on the way in which the economic processes are planned and governed, on the size of the material, the way they are managed and the way economic processes, human and other resources are carried out, the way these resources are assimilated into the economic cycle, the development of policies and the adoption of laws. This economic mechanism must be adapted to the needs and opportunities of the national economy, which change in a relatively short period of time and is a dynamic and coherent instrument. The research was based on bibliographic documentation, observation, induction supplemented with deduction, analysis with synthesis, as well as the logical method with the historical one. The results of the research lead to the existing similarities between Romania and the Republic of Moldova in terms of budget revenues and expenditures from the state social insurance budget by observing the same basic principles, rules and forecasts determined in the multiannual financial framework of both countries.

Cervical cancer screening and outcomes for women under 25 years of age in Belgium: a 10-year nationwide study.

The aim of the study was to describe trends in cervical cancer screening and outcomes for women under 25 years of age in Belgium between 2010 and 2019 in response to a changed reimbursement policy. We used the databases of the National Health Insurance Institute (RIZIV/INAMI) and the Belgian Cancer Registry (BCR) for a nationwide description of cervical screening, subsequent diagnostic procedures and outcomes for women younger than 20 years and women aged 20-25 years between 2010 and 2019. Over a 10-year period, the number of cytology screening tests and annual screening rates in women younger than 25 years have been reduced by 50%, but no increases in invasive cervical cancer or high-grade intraepithelial lesion diagnoses were observed. The major determinant of this decreased overscreening has been the limitation of reimbursement in 2013 to once every 3 years instead of once every 2 years. In women aged 25-29 years, there is no increase in invasive cervical cancer diagnoses after decreased screening of women younger than 25 years. To detect 29 invasive cervical cancers in women younger than 25 during the 10-year study period, a total of 5606 conizations were performed and 43 million EUR of Belgian health insurance budget was spent. Since the cost of hospitalization, sickness leave and negative psychological impact were not included in our estimation, these costs are underestimated. Incidence of cervical cancer in women under 25 years remains low and screening is not effective in preventing cervical cancer, although there is clear evidence of potential reproductive harm and financial cost. We state that restricting reimbursement of cervical cancer screening before the age of 25 will improve guideline adherence and decrease healthcare expenditures without negatively impacting the health of the population.

ANALISIS PELAKSANAAN PROGRAM JAMINAN KESEHATAN NASIONAL DI DINAS KESEHATAN KABUPATEN ROKAN HILIR

The National Health Insurance is part of the National Social Security System organized by the Health Social Security Administration (BPJS) through a mandatory social health insurance mechanism. The Social Security Administering Body. is a legal entity established to administer social security programs. Participants of the Health Social Security Administering Body are divided into 2 groups based on the origin of the funding. The first group is Contribution Recipients, participants in the category of those with economic difficulties. The second group of BPJS Health participants are those who belong to the Non-PBI (Contribution Recipients) group. The Health Service is an office that facilitates health and provides technical implementers of public health services that provide non-specialist individual health services for observation, diagnosis, treatment, treatment and or other health services. The formulation of the problem in this study is why the management of the National Health Insurance budget by the Health Social Security Administration at Balai Jaya Health Center, Rokan Hilir Regency has not been maximized. planning for the National Health Insurance in the working area of ​​the Rokan Hilir Health Service. This research method uses a qualitative approach with a descriptive type of research. The results of this study indicate that the planning of the National Health Insurance at the Health Office of Rokan Hilir Regency has not been implemented properly. This is based on the fact that there are still many people who have not been integrated into the National Health Insurance . Based on the Minister of Social Affairs Regulation Number 170 of 2015 the quota for JKN PBI Rokan Hilir participants is 184,419 people, but for JKN PBI Rokan Hilir participants it is only 1,762 people.  Keywords        : Planning, National Health Insurance

The guaranteed minimum income, an indicator of social protection for needy families: 1994–2022

This form of support was called social assistance. It was explicitly built around the idea of ​​minimum consumption and had as beneficiaries, especially people / families of working age, without a job, with children in maintenance. One year later, Law 67/1995 proposed the concept of guaranteed minimum income (GMI), designed to cover the consumption needs of the poorest (10%) of Romanians, identified by consumption expenditure per household, approximately 6% of Romanian households. The guaranteed minimum income is a very well-targeted allowance, which identifies people at risk of poverty and social exclusion, being based on testing means, depending on income, household possessions and land owned, and is granted on condition that the beneficiary works in for the benefit of the community, to discourage inactivity. Starting with January 2011, the necessary funds are provided from the state budget through the budget of the Ministry of Labor, Family and Social Protection and consist of financial benefits and services that include: the guaranteed minimum income; health insurance, without the obligation to pay the contribution to the health insurance budget.

Patients' Perspective on Their Experience of Dental Treatments Covered by Public Health Insurance in Romania-A Pilot Study.

Although the aims of any public health coverage are prevention, diagnosis, treatment, rehabilitation, and maintenance, dental services are hardly ever included in services. The goal of our pilot study is to assess the perspective of a group of adult patients on their covered dental treatments. The present cross-sectional study was conducted on 140 patients who reported their perception by filling in a questionnaire. All the collected data were statistically analyzed using IBM SPSS Statistics 25. Most of the subjects (40.7%, n = 57) were treatment oriented, visiting the dentist only in an emergency situation. A total of 40.7% (n = 57) of the participants stated that all the dental treatments had coverage and 22.8% (n = 13) had to split their treatment plan because of the insurance budget limit. The subjects who had chosen covered dental services because they considered it was a right they should benefit from (53.7%, n = 22) and those who had chosen covered dental services because of financial reasons (29.3%, n = 12) were more frequently unsatisfied with the types of covered dental services. The reduced level of satisfaction was associated mainly with the list of dental procedures accepted for coverage and also with younger and highly educated patients. For a more accurate description, the present study should be completed by future studies not only on a representative population at national level, but also by assessing the perspective of dental professionals.

Evolution of Public Health Expenditure Financed by the Romanian Social Health Insurance Scheme From 1999 to 2019.

The Romanian health system is mainly public financed (80.45%) through the following sources: Social Health Insurance (65%), State and Local Authorities Budget (15.45%), while the private sources (voluntary health insurance and out of pocket) adds an additional 19.55% to the public funds. The shares of the types of expenditure reflect the importance of each sector in the overall health system, and trends in expenditure show the impact of financing on the health sector's structural changes. We analyzed the 20-year trend of the Social Health Insurance budget, from 1999 to 2019. The influences of the different allocations, subcategories, and new budget categories appearing over time were adjusted to reveal relevant trends. Of the 14 medical service categories and the stand-alone Administrative expenditure category, six expenditure categories including Hospital services, Total drugs, and Primary care showed stationary 20-year trends; five including Medical devices, Dialysis, and Homecare services showed ascendant trends; and four including Dentistry and Emergency services showed descendant trends. Stationary trends imply no structural changes in the health sector of relevant magnitude to impact the financing shares of major categories: hospitals, drugs, or primary care. Emerging trends related to the impact of different reforms were revealed only in the low share of expenditures categories. The allocation methodology and statistical analysis of the trends reveal a new perspective on the evolution of health sector in Romania.

Underlying factors and challenges of implementing the urban family physician program in Iran

BackgroundThe family physician program was launched in 2005 in rural areas of Iran and then piloted in 2012 in the cities of Fars and Mazandaran provinces due to insufficient health coverage in these cities. However, despite its pivotal role in the health system, this program has not progressed according to the policies. This study aimed to explain the underlying factors and challenges of implementing the urban family physician program in Iran.MethodsThis qualitative study was conducted on 44 policy-makers and managers at national and provincial levels selected via snowball and purposive sampling with maximum variation. The data were managed in MAXQDA 2020 and analyzed by directed content analysis. A triangulation method was adopted for this purpose.ResultsA total of 10 categories, 18 sub-categories, and 29 codes were formed. Most challenges related to underlying factors included precipitancy, economic sanctions, belief in traditional medicine, belief in the expertise of previous physicians, and global ranking of countries. For program implementation, most challenges included a diversity of insurance organizations, budget allocation, referral system, electronic file, educational system, and culture building.ConclusionsThe major challenges pertaining to underlying factors included international pressure for reforms and precipitancy in program implementation due to management changes. The challenges associated with program implementation included budget provision and interaction with insurance organizations. Therefore, to expand this program to other provinces in Iran, the identified factors should be carefully considered so that sufficient confidence and commitment can be guaranteed for all stakeholders.

Value of Perampanel as Adjunctive Treatment for Partial-Onset Seizures in Epilepsy: Cost-Effectiveness and Budget Impact Analysis.

Introduction: China has ~6 million patients with active epilepsy every year, around 60% of whom suffer from partial-onset seizures. Perampanel (PER) is a novel anti-epileptic drug for partial-onset seizures. PER has been included in the latest Chinese National Reimbursement Drug List (NRDL) in 2020. However, there is still a lack of evaluation evidence on the value of PER in China.Methods: This study selected a health system perspective. A Markov model was established to simulate the lifelong transition of different response levels and calculate the number of seizures in Chinese patients. Based on the utility value and mortality risk, the life years and quality-adjusted life years (QALYs) of patients using PER vs. lacosamide (LCM) were estimated. Efficacy data were derived from clinical trials and the literature. Cost data (in US dollars) included drug costs and medical service costs. A lifetime horizon was adopted. Health outcomes and costs were discounted at an annual discount rate of 5%. Deterministic sensitivity analysis, probability sensitivity analysis, and scenario analysis were performed. The impact of the inclusion of PER in the NRDL on the medical insurance budget over 3 years (2021–2023) was also estimated.Results: Cost-effectiveness analysis indicates that 8 mg/day of PER increases QALYs by 0.054 and saves costs by $2,390 compared with 400 mg/day of LCM. 4 mg/day of PER increases QALYs by 0.010 and saves costs by $860 compared with 200 mg/day of LCM. Deterministic sensitivity analysis reveals that utility value and the extreme discount rate are the factors with the greatest impact on the incremental cost-effectiveness ratio. Probabilistic sensitivity analysis and scenario analysis show that the results are robust. Budget impact analysis indicates that after inclusion of PER in the NRDL, the incremental budget would be $1.28, $2.83, and $4.56 million from 2021 to 2023, respectively, but covering more eligible epileptic patients in the same time (1,918, 4,287, and 8,983, respectively).Conclusion: PER (8 or 4 mg/day) is of relatively high value as an add-on therapeutic regimen for partial-onset seizures in China because of its dominate advantage of cost-effectiveness over LCM and acceptable budget impact.

Budget impact analysis of the HIV/AIDS treatment on a national scale: a study from the Vietnam Social Security perspective

To analyze the budget impact of the HIV/AIDS treatment on a national scale, from the Vietnam Social Security (VSS) perspective. A model with a 5-year time horizon was developed. The total first year direct medical cost (DMC) and its cost components were estimated for HIV-infected populations each year. Budget impact was described through the proportion of the DMC over the social health insurance (SHI) budget. A scenario analysis was conducted with four settings of different proportions of members and coverage levels of the SHI. All costs were converted to 2020 US dollars. 1-way sensitivity analyses were conducted with variations of mean values in a range of ±25%. The total DMC was estimated at $1.8M (10,000 cases) to treat all new infections and $27.7M (150,000 cases) to reach the treatment goal of the Ministry of Health (MOH) in 2020. The total DMC accounted for 0.6% of the SHI budget for the year 2020 to meet the treatment goal. The costs of CD4-count test and fully suppressive regimen containing Tenofovir Disoproxil Fumarate (TDF) were identified as key cost drivers. The proportion of the total DMC over the SHI budget among different scenarios did not vary significantly. This is the first-ever study analyzing the budget impact of the HIV/AIDS treatment on a national scale, from the VSS perspective. The results showed that the cost of HIV/AIDS care was economical and the impact on the SHI budget was reasonable. Findings could be used to notify the MOH to allocate domestic resources and to optimize the current programs.

Cost Assessment of Inpatient Care Episodes of Stroke in Romania.

Introduction: Stroke is the second leading cause of death worldwide and Romania is no exception. There is a high economic burden associated with the treatment of stroke patients, which puts pressure on the healthcare budget. This study aims to measure the inpatient treatment costs of stroke patients in Romania.Methods: Our retrospective analysis follows stroke patients in six Romanian hospitals at different progressivity level from different regions. Patients are identified from the official hospital databases, reported for reimbursement purposes. Mean inpatient costs incurred with the treatment of these stroke patient episodes are calculated using the gross costing method. The cost data are derived from the management control system of the study hospitals.Results: 3,155 patient episodes of stroke were identified in the study hospitals. The average cost per stroke inpatient care episode sums up to EUR 995.57 (95% CI: EUR 963.74—EUR 1 027.39) in 2017, while the overall yearly healthcare burden adds up to EUR 140 million, representing 2.18% of the total national health insurance budget and a cost of EUR 7.15 per capita.Conclusion: The hospital cost of stroke inpatient care episode in Romania is high and it represents a sizable part of the healthcare budget, but it is among the lowest in Europe, which can mainly be explained by the level of economic development of the country. As both the number of patients and the cost of acute care are expected to increase in the future, the economic burden of stroke is also expected to increase.

PP387 Budget Impact Analysis Of Adalimumab In The Treatment Of Ankylosing Spondylitis In China

IntroductionAnkylosing spondylitis (AS) is a common disease that causes pain and affects productivity. Tumor necrosis factor-α (TNF-α) like adalimumab can bring better clinical efficacy and improve quality of life. Adalimumab is likely to be covered by health insurance. It is necessary to assess the impact of adalimumab for patients with AS on the medical insurance budget in China. Our research aims to give support evidence for policy-making.MethodsFrom the perspective of medical insurance payers, a budget impact model was established to evaluate the impact of adalimumab for the treatment of adults with severe active AS that has responded inadequately to conventional therapy. The time horizon was 5 years (2020–2024). The cost of measurement included drug and treatment costs for adverse events. Scenario analysis was conducted to evaluate the results under different drug price reimbursement ratios and treatment ratios.ResultsBased on the current price of adalimumab (CNY 3,160 [USD 446]/unit), under the reimbursement ratio of 70 percent, adalimumab will increase medical insurance expenditure by CNY 162 [USD 22] million, CNY 152 [USD 21] million, CNY 114 [USD 16] million, CNY 100 [USD 14] million and CNY 88.11 [USD 12] million in the next 1–5 years, respectively. The increased medical insurance expenditure accounts for 0.091, 0.085, 0.064, 0.056, and 0.049 percent of the annual medical insurance expenditure in the next 1–5 years, respectively, which is assumed to be equivalent to the expenditure in 2018 of CNY 1782.2 [USD 251] billion.ConclusionsThe budget impact of adalimumab for AS on medical insurance expenditure is limited, and including adalimumab in the medical insurance catalogue can reduce the burden on individuals, enrich treatment options, and satisfy clinical needs better.

PDG14 BUDGET IMPACT ANALYSIS OF GIPAP AND VPAP TERMINATION WITHIN THE NEXT 5 YEARS IN VIETNAM

Both GIPAP ang VPAP terminate in December 31st, 2019 in Vietnam, that would affect on treatment accessibility of patients. This study aimed to analyze the budget impact of both programs termination within the next 5 years in Vietnam to assess the association between Health Insurance budget and the accessibility of patients.

Patient Accessibility and Budget Impact of Orphan Drugs in South Korea: Long-Term and Real-World Data Analysis (2007-2019).

This study aimed to identify orphan drug accessibility and impact on pharmaceutical budgets in South Korea by analyzing the status of orphan drug designation, approval, reimbursement, and pharmaceutical expenditure. We analyzed the dataset on orphan drugs designated, approved, and reimbursed from 2007 to 2019 based on long-term real-world data. The designated and approved orphan drugs were 165 and 156, respectively, and 88 out of 156 approved products were reimbursed. Total expenditure on orphan drugs increased annually to account for about 1.44% of total pharmaceutical expenditure in 2018. Orphan drug expenditure per patient increased on average by 8.7% per year. The average annual cost of orphan drugs was USD 27,000–USD 47,000, with the maximum value of USD 260,000–USD 560,000. As there are a number of orphan drugs that have not yet been reimbursable after approval, a reimbursement policy should be established that considers the characteristics of orphan drugs. Since the rapid increase in orphan drug expenditure can be a potential threat to the insurance budget, budget management should also be considered. In conclusion, it is necessary to take preemptive measures to manage the health insurance budget efficiently while improving patient accessibility to orphan drugs.

노인장기요양보험제도에 관한 연구 - 일본을 중심으로 -

This paper aims to organize from the time of the introduction of the insurance system in Japan to the present, and to organize the main tasks of the insurance system. The four items were analyzed mainly for the modification of the insurance policy and its tasks in the provision of services, including the increase of the insurance budget and the use of services, the project to support caregivers (adopters) and the reaffirmation of the role of the 4 correctional village. The conclusion of this paper is that although the fundamental part of a change in the 1 insurance system is changing every time the policy is revised, the view that support the entire life of the elderly is important not just to provide