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  • 學位論文

藥品部分負擔政策對癲癇病人之影響

The Impacts of Drug Copayment Policy on Medical Utilization and Expenses for Epilepsy Patient in Taiwan

指導教授 : 薛亞聖

摘要


我國自民國88年8月1日起,實施藥品部分負擔政策,用以抑制不斷 增加之門診費用及藥品利用,本研究目的則在於探討藥品部分負擔政 策之效應;資料來源為民國87年、88年、89年與90年「健保資料庫」 資料及民國88年之「財稅資料核定檔」資料,並運用差異中之差異的 統計方法進行分析。  研究中以癲癇病人為對象,分析政策實施前後癲癇病人於短期(實 施後一年)與長期上(實施後二年),醫療利用與健康狀況的改變; 並藉此探討健保資料庫中「特定治療項目代號」欄位之正確性。 本研究主要研究結果如下: ㄧ、政策實施後,對癲癇病人醫療利用之影響:  1. 藥品費用:在總藥品費用與抗癲癇藥品費用上,於長短期均無         顯著改變。  2. 給藥天數:在總藥品天數與抗癲癇藥品天數上,於長短期均有         顯著減少。  3. 門診次數:在總門診次數與癲癇門診次數方面,於長短期均有         顯著減少。 二、以住院與急診為指標,政策實施後對癲癇病人健康狀況之影響:  1. 住院天數:在總住院天數方面,於長短期均無顯著改變;在癲        癇住院天數方面,於長短期均有顯著減少趨勢。  2. 急診次數:在總急診次數與癲癇急診次數方面,於長短期均無        顯著改變。 三、在以癲癇病人為研究對象下,發現健保資料庫中「特定治療項目   代號」欄位缺漏甚多;且該欄位有無資料者在多項醫療利用上,   均有顯著之差異。 綜上所述,本研究建議如下: ㄧ、藥品部分負擔政策宜繼續實施。 二、政府應提高醫師開立慢性病連續處方箋之誘因,且鼓勵病人和醫  師討論是否適合持慢性病連續處方箋領藥;以減輕真正有就醫需   求之慢性病人的負擔。 三、健保局應對該欄位存在之必要性進行評估,以避免造成後續研究   者之困擾。

並列摘要


Bureau of National Health Insurance (NHI) implemented drug copayment policy on August 1, 1999. This new policy was designed to reduce the growth of ambulatory care expenditure and prescription utilization. This study aimed to evaluate the impact of drug copayment policy, and it used NHI claim data from 1998 to 2001 and tax report information with difference-in-difference methodology to analyze. This study observed epilepsy patients’ medical utilization and health status for both short-term (i.e., one year after the policy) and long-term (i.e., two year after the policy) periods. Besides, it evaluated correction of “cure item” column in the NHI claim data by analyzing epilepsy patients. The main findings were concluded as below: 1.The impacts of epilepsy patients’ medical utilization and expenditure: (1) Prescription expenditure: There were no significant effects on total prescription expenditure and antiepileptics expenditure for both short- term and long-term periods. (2) Prescription days: There was a significant decrease on total prescription days and antiepileptics days for both short-term and long- term periods. (3) Ambulatory care visits: There was a significant decrease on total ambulatory care visits and epilepsy-related ambulatory care visits for both short-term and long-term periods. 2.Using length of stay and emergency care visits as health status indicator, the impact of epilepsy patients' health status: (1) Length of stay: There was no significant effect on total length of stay for both short-term and long-term periods, and there was a significant decrease on epilepsy- related length of stay. (2) Emergency care visits: There was no significant effect on total emergency care visits and epilepsy-related emergency care visits for both short-term and long-term periods. 3.By analyzing epilepsy patients’ medical utilization and expenditure, this study found there were lots of data missing in “cure item” column in NHI claim data. Besides, there were lots of significant differences from medical utilization and expenditure between patients who had records in the column and those who did not have records. Based on above findings, this study suggests: 1.It is appropriate to maintain the current drug copayment policy. 2.In order to release the financial burden for those chronic patients who really need medical cares,govern- ment should motivate doctors to prescribe more longer duration of medicine for chronic diseases as incentive. Meanwhile, government should encourage chronic patients to discuss with doctors to know whether they should take longer duration of medicine for chronic diseases or not. 3.In order to avoid more researchers will have been confused by NHI claim data in the future, Bureau of NHI should evaluate the existence of “cure item” column.

參考文獻


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