全民健保新藥給付績效評估之研究

The Study of Performance Evaluation on New Drug Benefit of National Health Insurance

曾條昌(Tyau-Chang Tseng)

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(2005年)

https://doi.org/10.6342/NTU.2005.02403

摘要

在威脅人類健康的舊病未除，新疾又接踵興起的情況下，新藥成為未來維繫人類健康的希望。然而新藥普遍價昂，各國健康保險財務壓力又大，對新藥是否列為健保給付項目，往往保守看待。但隨著國人日趨老化及醫藥生物科技之快速發展，新藥在我國經濟產業層面與改善國人健康等方面，無可避免地勢需擔負更多重任，值得相關當局及早投予更多的重視。
本研究藉由國人就醫資料檔案之分析，進行整體性新藥使用結果的評估結果發現：一、新藥給付整體趨勢方面：(一)健保新藥支出成長雖快，但並未造成藥費或醫療費用的失控；(二)健保新藥使用率與醫療院所規模成正比，且偏重於住院；(三)健保新藥使用率雖以住院為高，但支出集中在門診，且與住院支出額度差距逐年擴大；(四)心臟血管用藥為健保新藥支出大宗，但消化道與新陳代謝新藥則快速崛起。二、新藥給付績效方面：(一)新藥多用於醫療需求較高之病患，並對改善病況具一定成效；(二)新藥對使用者醫藥費用的主要影響，在於使用後之前二年；(三)公平性上：1.縣市存有新藥使用及資源配置之差異性，差幅雖有逐年縮小趨勢，但仍屬有限；2.規模較大之醫療院所新藥之藥費較高；3.重大傷病患者就醫開立新藥比率高於其他案件，其使用率住院又高於門診。(四)新藥給付仍屬進口藥天下，國資藥廠仍待加強扶持。
本研究建議以本研究為基礎，續對不同類別新藥進行深入追蹤，以瞭解各類新藥的確切療效及對藥費與醫療費用實際影響，並供未來新藥產業及保險給付政策之參考。

關鍵字

全民健保 ； 新藥給付 ； 績效評估

並列摘要

New drugs have been the promising new hope for the human being’s health; especially when the threat of the old disease still exists and the new ones are continuously showing up. However, new drugs are expensive almost and the economic pressure of the health insurance is a common problem for most countries; to accept new drugs as one of the insurance benefit items is not easy and is very hesitated for insurer. As the people’s aging problem is becoming serious and the developments of medical biology technology are rapid, new drugs inevitably should play more important roles and they are worth gaining more attentions from the government.
The research evaluates the usage of new drugs by analyzing the claim data from National Health Insurance (NHI). Some important results can be found as the following. First, for the whole trend for the new drugs payment: (A) Although the insurance payment for the new drugs is growing fast, the medical or drugs costs are still under control; (B) The usage of new drugs is proportional to the size of the hospital and most of them are consumed on inpatient; (C) The new drugs are used more on inpatient, but the payment is most due to outpatient, and the gap of amount between them is increasing annually; (D) Although the main new drugs claim is on the cardiovascular system , the new drugs claim for alimentary tract & metabolism patients is increasing rapidly. Second, the performance of new drugs insurance payments: (A) New drugs are used mainly for those who are higher medical demand and the effects to improve their health condition are noticeable. (B) the impact of new drugs to decline cost exists mainly during the first two years of its usage. (C) For the fairness of the new drug usage: (a) The resource allocation and usage of new drugs are different between cities and suburbs. The gap is narrowing annually but still very limited. (b) The new drugs claim is higher for bigger size of hospitals. (c) The prescription rate on new drugs for serious patients is higher than for other cases. (d) Most of new drug claims is paid for the imported drugs, so the local new drug makers should be helped to play as more important roles.
Based on the results obtained from this research, our study suggests that we should keep tracing the usage of different kind of new drugs and completely clarify the correct effects of the new drugs to the disease. Also the impact of new drugs cost on the medical care cost should be evaluated carefully. All these will be valuable reference for new drugs industry and for the benefits policy of health insurance.

並列關鍵字

national health insurance ； new drug benefit ； performance evaluation

參考文獻

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