의료기술평가와 공공정책

가톨릭대학교 보건의료경영대학원 2023년 2학기 (매주 목요일 18:30~20:10)

건강보장제도와 의료기술평가 – 영국

 2023.11.02 18:30 ~ 20:10

 발표

 영국 건강보장제도 개요
• 보건의료체계
• 의료기술평가

2
UK/ENGLAND

https://www.commonwealthfund.org/international-health-policy-
center/countries/england

3
UK/ENGLAND

4
개요

 인구 65M
• Life expectancy at birth: 81.2 years (78.4 vs 82.4) (2020)
• Leading causes of deaths: Dementia and Alzheimer disease, ischaemic heart diseases,
cerebrovascular diseases

 국가보건의료서비스 National Health Service

• Based on clinical need, not ability to pay
• Government allocates a set budget for health care in England
• Local level, clinical commissioning groups (CCGs) in England are responsible for
commissioning or planning health and care services in their respective areas
• HTA agency: NICE (England), Scottish Medicine Consortium (Scotland), All Wales Medicines Strategy Group (Wales)

5
개요

 재원
• Dominant general taxation / private health insurance, out-of-pocket payments
• The lowest levels of catastrophic health expenditure in the world
• Important exceptions including means-tested out-of-pocket payments for social care,
dental care, optometry and (in England) prescriptions

▪ 보건의료자원 부족
• Relatively low levels of either doctors or nurses, hospital beds, diagnostic equipment (CT,
MRI)
• Growing waiting lists for elective care (over 6M in 2022)

6
개요

7
개요

8
의료이용

9
의료이용

▪ 일차의료
• Delivered mainly through GPs, who act as gatekeepers for secondary care
• People are required to register with a local practice of their choice
• Most (69%) of practices operate under General Medical Services contracts, negotiated
between the British Medical Association (representing doctors) and government
• Physician payment is about 60 percent capitation for essential services, about 15 percent
fee-for-service payments for optional additional services (such as vaccines for at-risk
populations), and about 10 percent performance-related payments

• General practice is undergoing a structural change, from single-handed corner shops to networked
practices

10
주요기구

11
주요기구

12
의료기술평가

▪ MHRA
• Medicines and medical devices regulator (after Brexit)
• General Sale List, dispensed through pharmacist products, prescription-only medicines

▪ NHS Prescription Service

• NHS Drug Tariff (NHS Business Authority)
➢ Details reimbursement levels for drugs and medical devices

➢ Includes a black list and grey list of pharmaceuticals

➢ Control pharmacy profit (around 8%), control pharmaceutical industry profit margin (Voluntary
Scheme for Branded Medicine Pricing and Access, 594M ￡, 2020)
➢ The Accelerated Access Collaborative: accelerated assessment of novel medicines, promote uptake
of cost-effective drugs
➢ NHS Supply Chain service: support medical device procurement

13