全民健保制度下醫院採用學名藥之相關因素探討

Analyze Hospitals’ Generic Drug Purchasing Factors under the National Health Insurance

柯維信(Wei-Hsin Ko)

指導教授 ： 陳弘信

元智大學/管理學院/管理研究所/碩士(2008年)

https://doi.org/10.6838/YZU.2008.00091

摘要

台灣實施全民健康保險以來，醫療費用節節升高，造成健保財務的沉重負擔。健保局為了控制不斷的醫療費用成長，在2002年7月1日實施總額預算，在此支付制度之下，醫院如何控制成本支出，成為一個重要的課題。學名藥取代原廠藥是一個有效控制支出的方法。
醫院採購學名藥考慮的因素相當多，包括學名藥的品質因素、價格因素、及銷售藥品的公司因素，本研究做了兩點假說：一、會因治療疾病不同而改變採購學名藥的考量因素。二、大型醫院採購學名藥的考量因素，會與小型醫院不同。
本研究採問卷的方式，以桃園縣、新竹縣及新竹市健保給付為醫學中心、區域醫院及地區醫院為調查對象，由醫院藥劑部門主管轉發問卷與該院具有藥品採購決策之人員。
本研究發現治療疾病的嚴重程度較高的藥物，對於產品品質的要求看重程度，比治療嚴重程度較低分類的藥物來的高，這是因為治療疾病嚴重程度的藥物，多為急救藥物，治療疾病必須的藥物，使用品質不良的藥物可能會有治療不佳的因素存在，在這些藥物中，選擇使用學名藥會相當的謹慎。對於藥品公司因素的看法，也是治療疾病的嚴重程度的藥物組來的高，對於價格因素的看法，則兩組並無差異。大型醫院與小型醫院對於選擇學名藥的產品品質因素、價格因素、公司政策因素看法皆無差異，但需要進一步研究來釐清。

關鍵字

學名藥 ； 藥品採購 ； 全民健保

並列摘要

Since the operation of the National Health Insurance, Taiwan’s healthcare expenditures have been rising dramatically. The heavier financial burden of the National Health Insurance forces the Bureau of National Health Insurance execute cost control policies, including the “Global Budget” system implemented on 1st July 2002. Under the Global Budget reimbursement system, individual hospital’s cost control mechanism has becoming a very important issue. Replacing brand drugs with generic drugs has been proven an effective way of cost control.
Many factors will affect a hospital in purchasing generic drugs, such as drugs’ quality, price, and its manufacture. This study established two hypotheses: (1) Purchase determination factors vary by generic drugs’ targeting diseases; (2) Purchase determination factors of large-size hospitals are different from those of small-size hospitals.
This study surveyed medical centers, regional and area hospitals reimbursed by the National Health Insurance in Taoyuan County, Hsinchiu County and Hsinchiu City. The survey questionnaires were assigned to the pharmacy directors and disturbed to generic drug purchasing decision makers in those hospitals.
This study found that quality factor impacted more on generic drugs targeting on higher degree of disease severities than on those targeting on lower degree of disease severities. Because most drugs targeting on sever diseases are emergency medications, using poor quality generic drugs might result in poor treatment outcomes, hence such drugs will be chosen carefully. The factor of generic drug’s companies also impacted more on choosing drugs targeting higher disease severities. However, the price factor didn’t show the same pattern of difference. The study didn’t find significant impact differences in purchasing factors of drug quality, price, and policies of drug manufactures among large-size hospitals and small-size hospitals. Conducting further studies will be needed to clarify such ambiguity.

並列關鍵字

Generic Drug ； Drug Purchasing ； National Health Insurance

參考文獻

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