Outpatient Drug Expenditures and Prescription Policies for Diseases with High Cost to the National Health Insurance System in Taiwan

健保門診高醫療利用疾病之費用與用藥之政策分析

郎慧珠(Hui-Chu Lang) ； 賴美淑(Mei-Shu Lai) ； 陳昭姿(Gau-Tzu Chen)

《Journal of the Formosan Medical Association》 103卷4期 (2004/04) Pp. 280-285

https://doi.org/10.29828/JFMA.200404.0005

並列摘要

Background and Purpose: The high cost of drugs, particularly those used to treat upper respiratory tract infections, is an increasingly important problem for the National Health Insurance system in Taiwan. This study proposed a new classification scheme for reimbursing drug cost and estimated is impact on expenditures and health care utilization.
Methods: Data were obtained from the National Health Research Institutes' year 2000 computer file of the National Health Insurance Academic Research Database in Taiwan. Two factors were used to classify medications: 1) urgency of medications required; and 2) patients' self-care ability.
Results: Among the 10 diseases with the highest number of outpatients department (OPD) visits, 7 were upper respiratory diseases. Acute upper respiratory infection (URIs) and acute nasopharyngitis were the 2 disease with the highest number of OPD visits. Drug expenditure for acute URIs is about 6% of total expenditure for drugs. Medications suitable for URIs patients' self-care accounted for 42.8% of the total cost of prescribed drugs for these illnesses, and treatment medications unsuitable for patients' self-care accounted for 48.6%. Other medications used for URIs could not be grouped into these categories. The total expenditure for acute nasopharyngitis was about 1.3% of total expenditure for drugs. Medications suitable for self-care in patients with nasopharyngitis accounted for 51.8% of the total cost of medication prescribed for this illness, and medications unsuitable for patients' self-care accounted for 36.8%.
Conclusions: Reducing the medications suitable for patients' self-care and enforcing different levels of payment rates on medications unsuitable for patients' self-care may reduce the excessive use of OPD drugs, improve the appropriateness of utilization for acute URIs and the common cold, and allow medical resources to be distributed more efficiently.

並列關鍵字

Economics ； pharmaceutical ； Health expenditure ； Health insurance ； Respiratory tract infections