醫藥分業西醫診所門診處方釋出率及影響因素之分析

Impact of the Separation of Drug Prescribing and Dispensing Policy on the Release Rate of Prescriptions from Clinics

黃光華(Kuang-Hua Huang) ； 李玉春(Yue-Chune Lee) ； 黃昱瞳(Yu-Tung Huang)

《台灣公共衛生雜誌》 23卷6期 (2004/12) Pp. 469-478

https://doi.org/10.6288/TJPH2004-23-06-07

摘要

本研究目的在瞭解台灣醫藥分業政策實施前後處方箋釋出比例之趨勢，及影響診所釋出門診處方箋之因素。方法：本研究採次級資料分析，研究對象爲全民健保西醫分所，資料來源為國家衛生研究院1996~2000年全民健康保險學術研究資料庫中之全民健保西醫基層門診申報資料。結果：醫藥分業政策顯著影響處方釋出率，隨著實施地區人口比率增加，整體的處方釋出率雖仍相當低，但有顯著成長；都市化程度較高或較低地區、診所執業醫師數較少、每日服務量較低、專案案件相對於慢性病，一般珍所相對於專科分所，處方釋出可能性顯著較高；相對於耳鼻喉科，眼科、皮膚科、外科及婦産科釋出處方率顯著較低，而家醫或不分科、內科及兒科則顯著較高；病患年齡愈輕，疾病嚴重度愈低(A類疾病)處方釋出可能性顯著較高。結論：雖然本研究發現除醫藥分業外，環境因素、機構特性及病患特性皆顯著影響處方釋出率，但財務誘因可能才是最重要之因素。為落實醫藥分業政策，建議提高健保釋出處方誘因並降低藥品利潤，俾利整體處方釋出率之提升。

關鍵字

醫藥分業 ； 處方釋出率 ； 影響因素

並列摘要

This study aimed to investigate the trend and related factors of the release rate of prescriptions (RRP) to the pharmacies of primary care clinics with reference to the implementation of separation of drug prescribing (SDP) policy in Taiwan. Methods: Secondary data analysis was applied to the claim data of primary care clinics under the National Health Insurance scheme from 1996 to 2000. The database was obtained from the National Health Research Institutes. Results: The implementation of SDP was found to be related to the RRP. The greater the population covered by SDP, the higher the RRP, despite the low rate of RRP nationally. Clinics in the most and least urbanized areas, with fewer physician numbers and a lower patient volume, registered as specialist unit, and claiming the visits as special services rather than chronic diseases had higher RRP. Compared with E.N.T., those practicing family medicine, general practice, internal medicine, and pediatrics had higher RRP than those practicing gynecology, surgery, dermatology and ophthalmic. Regarding patients＇ characteristics, the younger, and the less severe (type A diseases) the patients were, the higher the RRP. Conclusion: Although this study found that environmental, institutional and patient factors, as well as SDP, all had significant impact on RRP, the financial incentives, still played the most important role. For the purpose of reinforcing the SDP policy and promoting the total RRP, it is recommended that NHI should increase financial incentives and reduce the profit gained from drugs.

並列關鍵字

separation of drug prescribing and dispensing ； release rate of prescriptions ； influence factors

參考文獻

Chou YJ,Yip WC,Lee CH,HuangN,Sun YP,Chang HJ(2003).(Impact of separating drug prescribing and dispensing on provider behaviour: Taiwan`s experience).

Ryan M,Bond C(1994).Dispensing physicians and prescribing pharmacists: economic considerations for the UK.(Pharmacoeconomics).

醫學研究

白佳昇、白佳原、張錦文、譚開元()。

行政院衛生署()。