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頁籤選單縮合
題 名 | 藥價調整政策對於過敏性鼻炎治療藥費之影響:以南部醫學中心2002年~2009年資料為例=Effects of Price Adjustment Policy on Drug Treatment for Allergic Rhinitis: A Case Study Using 2002~2009 Database from Southern Medical Center |
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作 者 | 潘志雄; 莊世杰; 翁慧卿; 潘豐泉; | 書刊名 | 寶建醫護與管理雜誌 |
卷 期 | 11:1 2013.06[民102.06] |
頁 次 | 頁2-15 |
分類號 | 418.25 |
關鍵詞 | 抗組織胺劑; 藥價調整; 過敏性鼻炎; 原廠藥; 學名藥; Antihistamine; Drug reimbursement; Allergic rhinitis; Original brand drug; Generic medicines; |
語 文 | 中文(Chinese) |
中文摘要 | 全民健康保險從1995年3月實施至今,已成為國人目前最倚賴的醫療保險制度,但因人口老化,疾病結構的改變,重大傷病患者增加等等,使全民健康保險財務問題日漸惡化,從1998年開始以呈現收入小於支出的現象,其中藥品耗用金額(pharmaceutical cost)由1997年的640億元增加到2009年的1,322億元,因此中央健保局於1999年3月30日及4月28日公告「全民健康保險藥 價基準」及「全民健康保險藥品支付價格調整作業要點」,以因應財務問題日漸惡化問題。過敏性鼻炎已是國内常見疾病之一,根據國内外許多對於過敏性鼻炎之相關研究,皆指出其盛行率有逐漸 攀升趨勢,而國内之盛行率約20%,故因治療過敏性鼻炎所耗用的醫療資源是值得關注的。因此 本研究目的為探討在「全民健康保險藥價基準」及「全民康保險藥品支付價格調整作業要點」規範下,藥價調整政策對於過敏性鼻炎治療使用抗組織胺劑原廠藥及學名藥趨勢。以國家衛生研究院釋出的「全民健康保險學術資料庫」,本研究分析由2002年至2009年各檔案資料共集女性125,713 人次、男性134,894人次,五家醫學中心及南區分局、高屏分局,以主診斷的國際疾病分類碼第九 版(ICD-9-CM)與「解剖學治療學及化學分類系統」(Anatomical Therapeutic Chemical, ATC code)代 碼篩選因治療過敏性鼻炎使用抗組織胺劑藥物共260,607筆資料,使用Microsoft Excel及SPSS 12.0 版統計套裝軟體作為資料處理與統計分析。研究結果顯示從2002年至2009年間因治療過敏性鼻炎 使用抗組織胺劑藥物就診人次有逐年減少現象,就診患者特質分析,男性大於女性,年齡成分佈以 37〜56歲最多其次為67歲以上老年人而1歲以下婴兒最少,私立財團法人醫學中心就診平均人次高於公立醫學中心,藥價調整政策藥品給付價調整對抗組織胺劑藥物原廠藥處方用量及金額逐年減少而學名藥則逐年增加,如依權屬別區分,公立醫學中心傾向使用原廠藥而私立財團法人醫學中心則傾向使用學名藥。近年來健保局為改善財務缺ロ而實施多項措施包含總額給付制度及藥價調査及藥品給付價調整政策,但這些措施並未與醫療品質及治療療效做結合,而導致許多醫療機構為達到收入目標在處方藥品採購上選擇折讓率高且具高利潤的學名藥,雖然健保局在實施藥品給付價調整後藥品給付費用可維持在總醫療費用的25%,,但因藥品更換後導致潛在性的醫療資源支出是無法評估的,因此建議相關單位能重新檢視目前總額制度及藥品給付價調整政策進行檢討並修正,能以醫療品質作為支付的依據,並透過支付制度的修訂使醫療資源重新分配,使藥品給付價趨於合理性與 臨床療效同時兼顧,讓醫療回歸以醫療品質為導向,採購合適的藥品與治療方式,讓病患獲得良好的醫療品質與專業照護。 |
英文摘要 | Since 1998 the income has been smaller than the expenditure appears, among them medicines consume rising from 64 billion in1997 to 1322 billion in 2009. In order to resolve the financial problems, the NHI implemented '' Pharmaceutical Benefit Scheme for National Health Insurance”(PBS) and “Guidelines of price adjustment for National Health Insurance reimbursed drugs” in Mar 30 and Apr 28 of 1999. Allergic rhinitis is a common disease in Taiwan; studies indicated that prevalence increases over time. In Taiwan the prevalence of Allergic rhinitis is about 20%, therefore the expense of the public health resources for allergic rhinitis should be concern. This project aims to investigate the impact of drug reimbursement policies on prescription of brand and generic antihistamine drugs in patients with Allergic rhinitis.Health care claim data from the National Health Insurance (NHI) program during the period 2002-2009, and the ATC 7-digit coding system of NHI Pharmaceutical Subsidy was used as the interface for analyzing the pharmaceutical claim data. In this study, 260,607 cases with allergic rhinitis analysis and prescription of antihistamine drugs were enrolled and analyses, among them 125,713 cases were female and 134,894 were male (data enrollment from 5 medical centers, BNHI southern and KAO-PING Branch). The analytic tools were Microsoft Excel and SPSS 12.0. Results indicated that from 2002 to 2009, the visits and prescription of antihistamine due to allergic rhinitis were decrease over time. Speciality analyze indicated that number of male is higher than of woman, age between 37 to 56 yr. The average visit times of patients were higher in private medica center than public center. The affect of Drug Reimbursement Policy on brand and generic antihistamine drugs prescription behavior were significant, of which the prescription quantity and amount of generic antihistamine drugs were increase and of brand antihistamine drugs were decrease over time. Distinguish by type of medical center revealed that private medical center tend to prescription of generic antihistamine drugs, but public medical center tend to prescription of brand antihistamine drugs. In order to improve the financial problems, several policies were implemented by BNHI, include Global Budget System, drug payment price adjustment and Drug Reimbursement Policy. However, the healthcare quality and therapeutic effect were not considerate when these policies implemented. Thus it makes medical sponsor choose generic drugs to obtain higher discount rate and profit. Although these policies makes the pharmaceutical cost maintain at 25% of total medical budget, but the potential medical expenditure can't be assessed when prescription behavior change. We therefore suggest that, relevant organization should revise these policies to make the medical resources distribution and payment system more reasonable and healthcare quality improvement. |
本系統中英文摘要資訊取自各篇刊載內容。