TITLE

Price determinants of medical procedures, devices, and medicine: A comparative analysis of national health insurance in five countries

AUTHOR
JY. KEUM (Innovation Center Operation Division, Health Insurance Review and Assessment Service, Wonju, Republic of Korea, Department of Public Enterprise Policy, The graduate School of Public Administration, Seoul National University)

1. INTRODUCTION

- Supply Disruptions: Several medical companies have stopped supplying certain countries with some type of medical supplies due to disagreements over prices, making hard for patients to access essential treatments.
- Price Conflict: Healthcare providers are pushing for higher prices, while policymakersare working to ensure equitable pricing for medical services.
- Lack of Communication: There isn’t enough discussion about what fair prices should be and what factors should influence those prices.

2. AIM
- Compare service fees across multiple countries.
- Analyze the cofiguration of causal factors influencing medical service fees.

3. METHOD
1) Target Countries: Australia, France, Japan, Korea, Taiwan
2) Fee Schedule Analysis: 202 physician services, 2,594 medical devices, and 37 studies of pharmaceuticals
3) Key Determinants
- Demand: Income, Age
- Resources: Workforce, Facilities
- Services: Outpatient visits, average length of stay
- Financing: Government schemes
- Publicity Level
- Regulatory Intensity
4) Statistical Analysis: ANOVA F-test, Tukey post hoc test, fuzzy-set qualitative comparative analysis (Fs/QCA)

4. RESULTS
1) Difference in medical prices: a significant difference between the averages of each country at the 1% significance level
2) Causal configuration
- High Medical Price: ~Demend * Resources * ~ Financing
- Low Medical Price: Services * ~Publicity * Regulation

5. CONCLUSIONS
1) High Medical Fees
- High medical fees arise when resources are abundant but medical demand and financial support from the health insurance system are low.
- In such cases, providers may set prices higher than the original price.
- Policymakers should increase financial support and offer incentives to prevent providers from reducing supply.
2) Low Medical Fees
- Low medical fees occur when publicity levels are low and healthcare provision increases, leading to cost-containment policies.
- To ensure quality, regulations should be gradually relaxed, and incentives like pay for coordination and performance should be provided.

6. ACKNOWLEDGEMENT
- The author gratefully acknowledges the Innovation Center Operation Division of the Health Insurance Review and Assessment Service, Dr. Seok-Jin Eom (Professor of Public Administration, Seoul National University), and Ph.D. candidate Minjun Hong (Teaching Assistant for Public Enterprise Management, Seoul National University) for their guidance on this article.

7. REFERENCES
- Akpinar, I et al Medical Device Prices in Economic Evaluations. International journal of technology assessment in health care 2015; 31(1-2):86-89.
- Francette Koechlin et al. Comparing Price Levels of Hospital Services Across Countries: Results of Pilot Study. OECD Health Working Papers 2010;53.
- Zhao, P et al A Worldwide Price Comparison of Glaucoma Medications, Laser Trabeculoplasty, and Trabeculectomy Surgery. JAMA ophthalmology 2018; 136(11):1271-1279.

8. CONTACT INFORMATION
- Jiyoung Keum: keum0603@hira.or.kr