全民健保個別醫院總額支付制度對精神科醫師處方行為影響之研究

Analysis of Psychiatrists’ Prescription Pattern Change Upon the Implementation of Hospital Price Regulation and Expenditure Cap by National Health Insurance In Taiwan

邱献章(Hsien-Jane Chiu)

指導教授 ： 劉順仁

國立臺灣大學/管理學院/高階公共管理組/碩士(2007年)

https://doi.org/10.6342/NTU.2007.10090

摘要

Chinese Abstract
目的 : 本研究欲了解醫療給付制度的改變，是否會影響醫師的醫療行為。故以精神分裂症患者的治療為例，檢視在實施醫院總額制度後，精神科醫師開立第二代抗精神病藥物的形態是否發生變化。
方法 : 由健保局提供的2001至2004年歸人檔資料中，選出43386立精神分裂症患者。實施醫院總額預算對於醫療行為的影響可能產生延遲效應，所以我們設定總額制度實施半年後為分界點，即2004年1月，以一般線性迴歸方程模式檢視分界點前後各醫院使用第二代藥物的藥費與頻率的趨勢。並按醫院的性質，分成 : 醫學中心與精神專科醫院，公立與私立醫院，分別檢視上述第二代藥物使用的情形。
結果 : 整體趨勢而言，在方案介入之前，第二代藥物藥費及使用率上昇，到介入點之後，即呈現停滯，不再成長(p = 0.0004)。在介入點後，與醫學中心相較，專科醫院的第二代藥物使用情形較不受影響(p < 0.0001) ; 而與私立醫院相較，公立醫院的第二代藥物使用情形較不受影響(p < 0.019)。
結論 : 抗精神病藥物之使用形態在實施醫院總額制度後失去持續成長的趨勢，故用藥形態在介入點後有明顯的變化。另外，隨著醫院形態的不同，使用第二代藥物的形態也有差異。如 : 公立精神專科醫院的藥物使用形態，最不受影響。進一步的方向應再檢視公立精神科醫院的核心價值，並嘗試在未來的精神醫療長期照護領域，強化其服務品質; 另一方面，尋找其他影響醫師醫療行為的因子，並向醫療政策決定者提出建言，制定更好的醫療政策，以嘉惠病人。

關鍵字

醫院總額預算制度 ； 醫師行為 ； 第二代抗精神病藥物 ； 精神分裂症

並列摘要

English Abstract
Objective: To examine the impact of the implementation of hospital-based global budget programs upon the psychiatrists’ prescribing pattern of Second-Generation Antipsychotics (SGA).
Methods: Data for this study were collected between 2001 and 2004 as part of the NHI database, which included exclusively patients with schizophrenia. For considering lagging effect of hospital-based global budget program upon the prescription behavior, we set a “dividing point” at January 2004, which is 6 months after the starting point of the implementation of global budget. We used general linear regression model to compare the trend of SGA use before and after the dividing point. Two indicators were calculated: proportions of SGA for drug expenditures and use frequency in outpatient and inpatient departments separately. Public sectors versus private sectors and psychiatric centers versus medical centers were examined respectively. The sample of this study consisted of 43386 individuals.
Results: The proportions of SGA in outpatient departments for expenditures and use frequency predominantly increased after Sep, 2002 (starting point of relaxed regulation on SGA use). After the dividing point, SGA proportions in outpatient and inpatient departments did not show obvious growing pattern as they did before the starting point, but appeared to be at a staggering pace lasting for 12 months (p = 0.0004). Compared with medical centers, the SGA expenditures of the psychiatric centers were less affected after the dividing point (p < 0.0001); compared with private sectors, the SGA expenditures of public sectors were less affected after the dividing point (p < 0.019)
Conclusions: We have revealed that psychiatrists’ prescribing pattern of antipsychotics is affected by the implementation of global budget programs; and the extent of influence varies by the types of hospitals, for example, public psychiatric centers are least affected by the implementation of global budget program. Further studies may engage in finding other factors affecting the psychiatrists’ behavior, and applying them on promoting the quality of life and mental-health care for those who are in need of psychiatric service.

並列關鍵字

hospital-based global budget ； physician behavior ； second-generation antipsychotics (SGA) ； schizophrenia

參考文獻

Reference Materials

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