- 學位論文
全民健保獨買模式下癌症用藥的競爭策略
A Study on the Monopsony of National Health Insurance and Competition Strategies of Oncology Pharmaceutical Companies
摘要
本研究探討全民健保給付行為。由於全民健保制度係由中央健康保險局擔任唯一的保險人，握有醫療市場的獨買權，相當程度地操控了醫療提供者的行為，隨著製藥產業在癌症治療研發上的進展，有必要針對癌症治療用藥給付問題進行進一步之研究。 本研究的目的在於了解惡性程度不同的癌症用藥，在健保局的核價基準上是否會有所差異？研究並從癌症處方成本以及病患延長存活期進行關連性的探討，以了解健保局對不同癌症用藥的給付狀況為何，以及在健保獨買模式下，台灣本土及國外製藥廠在市場寡占的經濟型態下在新藥推廣的經營策略為何？研究最後也將對健保當局的政策以及製藥廠業的因應之道提出建議。 本文的研究樣本分為三大部分，一部分是癌症的發生率與死亡率資料，資料來源為行政院衛生署所公布的民國 97 年癌症年度登記報告；另一部分為可以延長肺癌與結腸直腸癌病患存活週期的藥品資訊及建議劑量，這部分的資料則會取自近十年國際醫學期刊等有關肺癌與結腸直腸癌的臨床醫學治療研究；第三部分為台灣中央健康保險局所公告的癌症核定藥價。除了針對次級資料進行 M/I Ratio 惡性度的計算，本研究提出以癌症治療處方成本與病患延長存活期迴歸分析設計，以進一步了解其變項之趨勢變化。 研究發現，平均延長肺癌病患一個月存活期的成本為 NT$ 20,645，而延長結腸直腸癌病患一個月存活期的成本為 NT$ 13,862，滿足惡性程度的高低對於藥品定價會產生差異的假說。而肺癌處方成本與病患存活期的迴歸分析斜率為 0.404，相較於結腸直腸癌的 0.614 為低，顯示健保局也因為考慮到癌症的惡性程度，而反而提供肺癌用藥較好的給付價格。從資料圖表顯示，肺癌與結腸直腸癌都偏向於直線型，意即此兩種癌症用藥目前並無邊際效益遞減的問題，也就是到癌症用藥的研發後期，健保局會進行藥價的抑制。
並列摘要
The Bureau of National Health Insurance is the only insurer due to the National Health Insurance system that acquires the right of monopsony and control the behavior of medical providers in certain degree. With the progress of the cancer treatment development in the pharmaceutical industry. It’s necessary to study further about the National Health Insurance payment problems for cancer treatment. The purpose of this study is to understand if there is any difference of drug payment scheme in different degree of malignancy of cancer drug. It also explores the relationship between the treantment cost of cancer and the overall survival time of patients. Therefore, we can figure out the drug promotion and management strategies of the pharmaceutical industry under the circumstance of insurance monoposony. This article will also propose how the government and pharmaceutical companies can react for better policy or management. The sample of this study is divided into three parts, one is the statistic data of cancer incidence and mortality rate from the report of department of Health announced in 2010; another part is about the suggested dose of the lung and colorectal cancer for survival period extension, this kind of documents are collected from the international medical journals in the past 10 years; the other part is the approved drup price announced from the Bureau of National Health Insurance. The research method contains the calculation of M/I Ratio and the regression analysis of treatment cost and overall survival time. The study found that the avarage cost to extend one month survival of a lung cancer patient is NT$ 20,645, and NT$ 13,862 for colorectal cancer. The different degree of malignancy will result in the approved drug price. In the other hand, the Bureau of National Health Insurance is willing to give better payment for the cancer treatment with worse malignancy. According to the regression chart, the lung cancer and colorectal cancer are both in linear model which means there is no diminishing marginal utility. In other words, the government will tend to restrain the drug price in the end of the treatment development cycle.