- 學位論文
全民健保取消部份指示用藥給付對門診用藥型態的影響
The Effect of Outpatient Prescription Patterns by Health Insurance Cancel Drug Payment about Part of Over-The-Counter Drugs
摘要
摘要 研究目的 健保局希望藉由限制給付藥品品項，來抑制藥品費用支出持續增加的現象。探討在取消部份指示用藥制酸劑給付的政策下，取消的指示用藥品項與同藥理作用的處方藥和未取消給付指示用藥之間的藥品替代情形。 研究設計 前測/後測準實驗設計。以醫院為分析單位，觀察2005年10月全民健保取消部份指示用藥給付後，比較2005年前三季與2006年前三季的制酸作用藥品用藥頻次，以同家醫院是否因取消部份指示用藥而改變其處方行為，並發生藥品替代情形。以配對t檢定與t檢定進行替代情形的檢定。控制變項為醫院層級別與醫院權屬別。 資料來源 全民健保資料庫2005年與2006年的資料，包括系統抽樣檔中的門診處方醫令明細檔(OO)與醫事機構基本資料檔(HOSB)。還有健保給付藥品ATC代碼對照檔和取消指示用藥制酸劑健保給付品項暨價格明細表。 研究對象 429家醫院。 結果測量 用藥頻次及替代指標(S)。用藥頻次為計算藥品品項申報次數；替代指標的分子為同藥理作用未取消給付品項增加的用藥頻次，分母為同藥理作用被取消指示用藥減少的用藥頻次。 主要結果 （一）2006年抗潰瘍處方藥與未取消給付指示用藥制酸劑之用藥頻次有增加。 經配對t檢定後，全部醫院、各層級醫院全部有增加但不顯著（p＞0.05）； 各權屬別醫院僅財團法人醫院有顯著增加（p＜0.05）。 （二）藥品替代指標S值經t檢定分析，顯示無替代現象。 經S值t檢定後，全部醫院 、各層級醫院、各權屬別醫院皆不顯著（p＞0.05）。 結論 當全民健保取消部份指示用藥給付政策實施之後，對於同藥理作用之處方藥與未取消給付指示用藥，醫院增加使用的情形並不明顯，預期的替代現象並未出現；但針對財團法人醫院有使用顯著增加的情形。 關鍵字：指示用藥、藥品替代、處方型態、全民健保
並列摘要
Abstract Research purposes. Drug expenditures had increased continuously. Bureau of National Health Insurance(BNHI) in Taiwan expected to restrain the phenomenon by restricting the payment of drugs items. This study explore the effect of delisting over-the-counter (OTC) drugs from National Health Insurance(NHI) on outpatient prescription patterns. This study wants to investigate the relationship of drugs substitution, among delisting OTC drugs, prescription drugs and uncanceled OTC drugs. Designs. The quasi-experimental design is Pre-test/Post-test Design. The analysis unit bases on hospital.The data is from NHI program during the period 2005-2006. The hospitals changed their prescribing behavior if BNHI delisted OTC drugs. This study estimates the occurrence of drugs substitution that tested by paired t-test and t-test. These controlled variables are the hospital level and hospital ownership. Data. The databases came from NHI including details of ambulatory care orders (OO) of systematic samples and registry for contracted medical facilities (HOSB). And the ATC 7-digit coding system of the NHI Pharmaceutical Subsidy will be used. And delisting OTC drugs of the NHI Pharmaceutical file listed price with items. Subjects. 429 hospitals. Main outcome measures. Prescription frequency and substitution indicator of drugs(S value). Main results. (A) For the same ATC category, the prescription frequency of prescription drugs and uncanceled OTC drugs increased from 2005 to 2006. Total hospitals and hospitals at every level increased but not significant (p >0.05); For hospitals ownership, Non-Profit Proprietary hospitals increased significantly (p <0.05); but the others do not. (B) Substitution indicator of drugs (S value) is not significant by t test (p >0.05). Conclusions. After NHI executed the policy of delisting OTC drugs, hospital prescription frequency of prescription drugs and uncanceled OTC drugs were not increased obviously. Moreover, the expected drugs substitution did not appear. However , Non-Profit Proprietary Hospitals increased significantly. Key words: over-the-counter, drugs substitution, prescription patterns, National Health Insurance.
參考文獻
延伸閱讀
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