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    Title: 健保給付制度對藥品使用的影響
    Authors: 黃達夫;謝啟瑞;羅光達;孫佳鳳;吳仁佑
    Contributors: 行政院衛生署
    財團法人黃達夫醫學教育促進基金會;國立政治大學財政系
    Keywords: 全民健保;藥品政策;新藥;藥品使用;藥價;技術擴散;NHI;drug policy;new drug;drug utilization;drug price;technology diffusion;藥學;公共衛生學
    Date: 2006
    Issue Date: 2010-10-05 16:06:53 (UTC+8)
    Abstract: 本計畫的主要目的,是要探討全民健康保險的藥品給付政策對藥品使用的影響。研究的方法包含總體加總資料(aggregate data)的敘述性分析,與個體資料的量化分析。總體資料的敘述性分析,是從宏觀的角度,分析全民健保藥品給付項目調整、藥品給付限制、藥價支付基準、新藥給付與臨床用藥指引等藥品政策對藥品使用的影響。藥品使用的研究範圍,涵蓋藥費申報金額、用藥種類、採用新藥比例、進口藥與國產藥比例、給藥天數與處方項目等六大面向。我們的研究除了彙整藥品政策與藥品使用在過去1997-2002年之間的動態趨勢之外,也將深入分析各種藥品政策動態調整對藥品使用所可能產生的動態衝擊。個體資料的量化分析,則是以新藥納入給付為例,以計量經濟學的數量分析方法,實證檢定政策的影響效果。在這項研究之中,我們將新藥品視為新的科技,應用經濟學探討技術擴散的文獻,分析健保的藥品給付規定、新藥的支付價格、醫院巿場與藥品巿場的競爭程度、以及醫院的特性等因素,對新藥使用擴散速度的影響。根據經濟學的理論與台灣藥品市場的結構特性,我們提出六個影響新藥使用擴散速度的實證假說,並結合全民健保資料庫與藥品價格等多項資料進行實證檢定。許多文獻研究顯示,持續不斷上市的新藥,對改善國民健康有顯著的貢獻,但同時也成為許多國家醫療支出快速上升的原動力。因此新藥的擴散速度在不同醫院之間若有顯著差異,不只會影響到整體醫療資源的使用效率,也會影響到國民健康的不均等,進而影響到全民健保制度的公平性。綜合以上兩種研究方法的分析結果,我們將可分別從宏觀與微觀的角度,描繪出全民健康保險的藥品給付政策對藥品使用效率與健康分配公平的影響 The purpose of this research is to examine the effects of pharmaceutical policy on drug utilization under the system of National Health Insurance (NHI) in Taiwan. The descriptive analysis of the aggregated data at the macro-level and the quantitative analysis at the micro-level will be presented in this study. In the macro-level analysis, the trend of pharmaceutical policies on drugs utilization during the past ten years will be presented first. We will also focus on the policy impact of the pharmaceutical expenditures, drugs prescribing patterns, the ratio of new drugs, the ratio of imported to domestic drugs, and the average day and number for each prescription. The policy elements include the reimbursed drug items, the criteria and limits of drug payment, the approval process for new drugs, and the prescribing guidelines. In the micro-level analysis, we will quantify the effects on new drugs reimbursement approval policy by using the econometric analysis. In this paper, the new drugs are treated as new medical technologies. Based on the economic theories and the characteristics of market structures in Taiwan, we identify the six factors that affect new drugs technology diffusion, including the reimbursement rules of drugs, reimbursement prices for new drugs, the market of hospitals, technological innovation of new drugs, the degree of competition of pharmaceutical markets and hospital-wide market competition. Using the NHI database, we test the effects of these factors on new drugs diffusion. This research will not only present a long-term trend of the drug utilization at the macro-level, but also examine the impact of new drugs payment policy on drug utilization at the micro-level. We expect that this study will provide useful information of pharmaceutical policy reform in the future for health policymaker in Taiwan.
    Relation: DOH94-TD- D-113-041-(2)
    應用研究
    委託研究
    研究期間: 940701~950630
    研究經費: 1099 千元
    Data Type: report
    Appears in Collections:[財政學系] 研究報告

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