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    题名: 我國藥品採 reference price 之模擬研究
    作者: 周麗芳;陳曾基;章樂綺
    贡献者: 中央健康保險局
    台北榮民總醫院;國立政治大學財政系
    关键词: 參考價格;藥品;健康保險;reference price;pharmaceuticals;health insurance
    日期: 2000
    上传时间: 2010-10-05 15:39:39 (UTC+8)
    摘要: 研究目的: 詳述相關國家實施藥品reference price的情形;模擬分析我國藥品reference price的計算方式,並提出關於我國採用藥品reference price方案的建議。

    研究方法: 本研究分為制度面與實證面兩大部份。制度面將介紹國外reference price實施情形,分析方法則以整理描述為主。實證面則初步建立我國reference price的模型,並依據實際健保用藥價量資料進行模擬分析。

    主要發現: 制度面詳述國外五個國家(德國、加拿大英屬哥倫比亞省、紐西蘭、義大利、瑞典)的相關制度,特別是德國的therapeutic reference pricing。實證面則依據國家衛生研究院全民健康保險學術研究資料庫抽樣檔(CD1997S20與OO1997S20),以Nifedipine、鈣離子阻斷劑分別當成第一、二級reference price藥品的例子,討論我國reference price的可能模型,並進行模擬分析。囿於本土實況,可行模型的種類與計算方式較為單純,其中利弊互現。

    結論及建議: 實施藥品reference price制度應有兩大前提要件:(一)放寬保險對象不得自負差額的限制規定;(二)統一藥品價格,或者透過與藥界的協定,保證每一種藥品的差額負擔額度全國一致。此外,在行政作業程序上,還需注意:藥品的歸類與分組、reference price基準的決定、實施優先次序、配套措施、監控變化、自動化程序、以及正常立法程序等事項。
    Background and Purpose: The "reference pricing" within the health insurance system generally means the reimbursement of a class of pharmacologically or therapeutically equivalent drugs according to the price of a single drug or a calculated (reference) price in the group. The insured must pay the difference between the actual market price and the reference price of a drug he receives. To set reference prices not only involves the cost shifting between the insurer and the insured, but also may interfere with the dynamic development of pharmaceutical industry. The study is to collect relevant literature of reference pricing around the world, propose a suitable plan for Taiwan's National Health Insurance, and conduct a simulation study.

    Methods: The study consists of two parts. The institutional part describes the situation of reference pricing in other countries. The empirical part attempts to construct models of calculating reference prices and to conduct a simulation study on base of to the local data.

    Results: The institutional part describes the situations in Germany, Canada (British Columbia), New Zealand, Italy, and Sweden, esp. that in Germany in full details. The empirical part takes the Nifedipine and calcium channel antagonists as examples, and utilizes the data from the research databases of the National Health Research Institutes (CD1997S20 and OO1997S20). The possible models of calculating reference prices are proposed and the simulation study conducted.

    Conclusions and Recommendations: There are two premises of implementing a system of the pharmaceutical reference pricing: (1) deregulating the some limitation of cost sharing, and (2) unifying the drug prices. Besides, attention should be pay to the grouping of pharmaceuticals, the standard of calculating the reference price, the priority of implementation, the associated measures, the monitoring mechanism, the automation procedure and the issues of legitimation.
    關聯: DOH88-NH-025
    研究期間: 8804~8906
    数据类型: report
    显示于类别:[財政學系] 研究報告

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