The Influences to Clinical Prescription after the Implementation ofGlobal Budget System and Price Adjustment of Pharmaceuticals- A Study of Prescription Behaviour of Drugs for Diabetes with CAD

• Main Authors: Chen, Hsiang-Yin, 陳香吟
• Other Authors: Hsu, Sue-Ming
• Format: Others
• Language: zh-TW
• Published: 2010
• Online Access: http://ndltd.ncl.edu.tw/handle/37221518392558574072

碩士 === 東海大學 === 管理碩士在職專班 === 98 === The establishment of National Health Insurance (NHI) in 1995 has entirely changed the public health care environment in Taiwan. The implementation of “Global Budget System” in 1998 and “Price-Adjustment” in 1999 has been bringing bigger changes and impacts. What are the factors that influence clinicians prescription behavior regarding patented drugs and off-patent drugs due to the implementation of “Global Budget System” and “Price-Adjustment”？And, is the price of drugs the key factor for physicians’ prescriptions as indicated by the previous research results? This study is based on the data in National Health Insurance Research Database from 1998 to 2006. The major areas of the study include as the followings. 1. The Global Budget System Based on the prescription volume changes of lipid-lowering agents (Statins, Fibrates and Aspirin) in the diabetic patients with CAD before and after the implementation of “Global Budget System”, this study identified the related influencing factors of prescription behavior by logistic regression statistical analysis. Results: The prescription of Aspirin was almost the same in the diabetic patients with CAD or without CAD after the implementation of “Global Budget System”. However, the prescription of Statins showed a continuous growth. Furthermore, there is a trend of newly developed Statin drug replacing old Statin drug., And there is a decreasing trend of prescribing Fibrates even though Fibrates are low cost regimens and most of them are off-patent. 2. Price-Adjustment Based on the prescription volume changes of lipid-lowering agents (Statins, Fibrates and Aspirin) in the diabetic patients with CAD during the five times implementation of “Price-Adjustment”, this study identified the related influencing factors of prescription behavior by logistic regression statistical analysis. Results: The prescription volume of Statins showed a continuous increasing trend. The VII increasing trend is more significant for the newly developed Statin drugs, i.e. Atorvastatin and Rosuvastatin. In the meanwhile, the prescription of the old Statin drug Simvastatin showed a declining trend. The prescription of Fibrates is continuously declining except the latest Fibrate Fenofibrate but the prescription of Aspirin showed a continuous growth. 3. What are the key factors of influencing prescription volume？ Results: Prescription is a complex clinical behavior, influenced by multiple causes, which is not entirely determined by the health insurance policy. The results of this study show that “disease” and “drugs” are the two key factors to determine the volume of prescription, rather than "drug price". Even if NHI has put a cap on the amount of prescription and adjusted the drug prices in order to reduce their expenditures on drugs, clinicians continue prescribing medication based on clinical treatment guidelines to take into considerations of patient medication needs, but drug price is not the key deciding factor. Using the NHI system to influence the prescription behavior, such as Global Budget System and Price-Adjustment, is only a game, while the outcome (win or lose) is still determined by wrestling of multiple factors. 4. Analysis of dynamic capabilities and strategic management of R&D pharma- ceutical companies Recommendations: i. Have research and development to focus on special therapeutic areas. Build more outsourcing and cooperation. Outsource non key components of R&D to service providers to reduce R&D cost and shorten the development time. ii. While outsource the exclusivity-expired products to qualified local distributors to ensure continuously generating significant revenue, focus on marketing those exclusivity products. Pharmaceutical companies should no longer focus on maximizing revenues, but rather to obtain the maximum profit as the ultimate business goals. iii. Related health care industries form co-operation and strategic alliances to generate greater synergy for providing health care services, in order to overcome the barriers and to strengthen competitive advantage.