阿茲海默氏症治療藥品在我國全民健康保險藥品給付規定之探討

An Investigation of the Payment of Anti-Alzheimer Drugs by National Health Insurance in Taiwan

陳偉熹(Wei-Hsi Chen) ； 吳紹琛(Shou-Shun Wu)

《東港安泰醫護雜誌》 14卷1期 (2008/06) Pp. 1-15

https://doi.org/10.7078/TSMHMNJ.200806.0001

摘要

在我國全民健康保險中，每年至少支出15億元予以處理各種失智症之醫療狀況。阿茲海默氏症為最常見的失智症，所用之治療藥物，是屬於高單價種類，主要功能是延緩或穩定症狀惡化，而不具治癒之能力。因此，考量全民健康保險之財政狀況和醫療結果，在決定給付時必須謹慎。目前阿茲海默氏症治療藥品之給付，在初次申請時必先符合成立要件和排除條件；在繼續申請和病情改變申請時亦有明文規定。然而，爭議仍然不斷產生，尤其是排除條件之標準不明確、繼續申請時評估方法之簡易，智能狀態測驗空隙過大，因而導致輕度病患可能必須停止使用藥物，反而其他較嚴重之病患則符合使用藥物規定而得以繼續，和病情改變時無法換藥等之窘境。在經過思考多個可能性後，欲改善目前之給付規定，使之趨向更人性化和發揮醫療功效，減少行政資源浪費，吾人建議申請人在初次申請時必須備妥排除方法和檢驗結果，並且將之清楚呈現在申請書上；審查人必須了解排除條件之目的。另外，當病患之智能評估在追踪時雖然下降卻仍未達到改用救濟途徑前，依目前狀況可以改用臨床失智評估量表為評估方法去改換另一種藥物繼續治療；亦建議嘗試有條件開放換藥。至於因副作用而必須換藥者應放寬時間和藥物種類限制。無論如何，在社會財政、醫療資源和國民健康之間，面對給付規定中所產生之爭議，醫療人員應避免知識濫用，浪費資源和對其他病患產生排擠效應。

關鍵字

阿茲海默氏症 ； 失智症 ； 全民健康保險 ； 治療 ； 給付規定

並列摘要

In Taiwan, the National Health Insurance pays over 15 billion for dementia and related conditions annually. Alzheimer disease is the most common type of dementia, and its therapeutic agents are belonged to the high-expensive class of medications. Since these anti-dementia drugs could only delay or stabilize dementia, but not cure, so a strict and careful review of their payment basing on the budget of health insurance and medical outcome is necessary in order not to edge out other items. Currently, physician should firstly apply for permission from National health Insurance Bureau to pay for anti-dementia agents for Alzheimer disease, and the application, that should fulfill the inclusive and exclusive criteria of the regulations, is reviewed by examiners who are also neurologists come from different medical centers. Regulations are also stipulated for continuous and drug-change application. However, argument continuously occurs and is blamed for ambiguous standard for exclusive criteria, a wide gap of Minimental State Examination, and impracticable of drug-change regulation. We suggest that applicant should clearly record the method and type of inclusions and reviewer should understand the aim of inclusive criteria. Using Clinical Dementia Rating instead of Minimental State Examination can fill in the gap when the latter falls over the regulation demanded. Also, conditional drug-change can be tried. The regulation for drug-change due to side effect should also open for time and type of drugs. Among government budget, medical resource and health, physician should avoid abuse of medical knowledge, resource and to edge out others.

並列關鍵字

Alzheimer disease ； dementia ； National Health Insurance ； treatment ； policy of Payment