Examination of Medical Care Fees in the National Health Insurance System by Pharmacist-examiner. (II). Analysis of Re-examination of Pharmacist's Fee Claim Forms.

The actual state of re-examination of the pharmacist's fee claim forms is unsufficiently understood for both medical care institutions and insurance-pharmacies. Accordingly we analyzed contents of 881 among 1440 cases which had been actually re-examined by the National Health Insurance Examination Committee of Medical Fees in Fukushima Prefecture in January 1996.Three-fourths of assessment cases corresponded to one of the official reasons, “Not indication” . Pharmacists in the medical care institutions should examine the actual plan for contribution to appropriate legal prescription delivery. Moreover it is impossible for insurance-pharmacies to assess pharmaceutical management and counseling service when the patient's disese is unclear. It is thus necessary to construct the system based on the patient's information being mutually available to medical care institutions and insurance pharmacies.