台灣製藥產業經營績效評估之研究—以全民健康保險支付制度觀點

目前全民健保全國納保率約為97%，對醫療產業而言健保局是最大的付費者，而全民健保支付制度已經改變醫療院所的生產效率，致使其對各項成本支出的考量將會益發嚴格，而藥品則佔醫療院所1/4的支出費用，勢必將會影響製藥產業經營績效的變化，因此本研究旨在探討台灣製藥產業經營績效是否因不同的全民健保支付制度而有所改變，提供日後製藥產業經營績效改進的方向。本研究使用資料包絡分析法評估公開發行之生技製藥廠商中，依照其生產組合篩選人用西醫藥品產值占其全部產值50%以上之廠商，計算民國85-89年（論量計酬支付制度施行期間）與民國92-97年（總額預算支付制度施行期間）之營運效率，投入項為員工人數、資產總額、研究發展費用，產出項為營業收入淨額。本研究共有14家廠商和137個DMU，其中47個DMU個屬於民國85-89年論量支付制度實施期間，90個DMU屬於民國92-97年總額支付制度實施期間。比較總效率值與純粹技術效率值可以發現總額支付制度施行期間（民國92-97年）相較於論量計酬支付制度期間（民國85-89年），所有研究對象均呈現下降的趨勢，可以看出在不同健保支付制度的時期之經營績效確實有明顯的不同。此外，本研究實證結果發現，在研究發展上投入較高比重的廠商，在經營績效的表現上是不如研發比重較低的進口藥品代理商或製造商，除產業特性的影響外，國內產業環境尚未完全成熟及研發人才的缺乏應也是影響不同類型廠商間經營績效好壞的原因，顯示廠商需正視全民健保支付的改變所帶來的影響，並提昇其自身的經營績效，來維持企業發展。

關鍵字

全民健保；製藥產業；資料包絡分析；經營績效

並列摘要

The Coverage of the National Health Insurance (NHI) is 97% in Taiwan. Bureau of NHI is the main payer of hospitals. NHI payment has already changed hospital’s production efficiency. Thus they will be more cautious their cost. However, there are 1/4 cost in the medicine. It will be effect the performance of pharmaceutical industry. The purpose of this study is evaluative that influence of the pharmaceutical industry performance with different NHI payment systems. We use DEA model to determine the factors in period of 1996-2000 and 2003-2008. There are three input items (including of number of employees, total assets, research and development expenses) and an output item (net operating income).We have 14 pharmaceutical companies (137 DMUs). There are 47 DMUs for the period of 1996-2000 (by Fee-for-service) and 90 DMUs for the period of 2003-2008 (by Global budget payment system) To compare the period of Fee-for-service and period of Global budget payment system in the technical efficiency and pure technical efficiency, we can find that performance is reduced. They are really difference between fee-for service and global budget payment system. The performance of companies which are less R&D expenses is better than those which are more R&D expenses. Different performance between companies is not only because of the characteristic of Pharmaceutical Industry but also because of the environment’s development is not completed and the researchers are deficient. The conclusion draws that the companies have to understand the influence of NHI payment system, to improve their performance and to maintain their development.