The Study of Price Difference of Pharmaceutical Procurement Under the Rules of National Health Insurance Payment System

• Main Authors: Hsuan-Yu Lai, 賴炫羽
• Other Authors: Tsung-Jung Liu
• Format: Others
• Language: zh-TW
• Published: 2011
• Online Access: http://ndltd.ncl.edu.tw/handle/88330481386206516773

碩士 === 東吳大學 === 法律學系 === 99 === ABSTARCT “Pharmaceutical price difference” means the price difference between that NHIB pay for reimbursed drugs and that NHI contracted medical care institutions actually pay for pharmaceutical procurement. The amount of pharmaceutical price difference has already accumulated more than thirty billions after six times price investigations and adjustments for NHI reimbursed drugs. The pharmaceutical price difference is usually accused of medical expense waste and causes the NHI finance to worsen. The NHI financial deficit is due to insufficient insurance premium income, not pharmaceutical price difference. To narrow down pharmaceutical price difference will establish new allocation ratio for NHI expense. As the insurer, the NHIB must provide medical care to the insured and this obligaion is usually achieved by NHI contracted medical care institutions. The pharmaceutical procurement contract is fundamentally a “private trade contract” between NHI contracted medical care institutions and pharmaceutical companies. As the actual payer of drugs price, NHIB indirectly interferes in private pharmaceutical trade by “Market price survey and adjustment”. “Pharmaceutical price difference” is an unavoidable phenomenon under the NHI payment system now. It will help NHIB to reduct the price of NHI reimbursed drugs so that NHIB could revise the allocation ratio for NHI expense. Reasonable pharmaceutical price difference could be an adquate profit and compensate the cost of procurement for NHI contracted medical care institutions. The most criticized issue is about the influence of pharmaceutical price difference on order of pharmaceutical trade and physicians’ prescription. The contracted medical care institutions declare to NHIB the expense of drugs based on “Pharmaceutical Benefit Scheme for NHI” after delivering the prescription and dispensing drugs to the insured. Although the contracted medical care institutions get the profit from pharmaceutical price difference, they don’t violate the civil code or the criminal code or administrative code so that the profit is legal. When the NHI contracted medical care institutions and pharmaceutical companies were found of fraud or denied reporting drugs selling information during market price survey period, they will be punished according to not only “Pharmaceutical Benefit Scheme for NHI” but also the criminal code. For NHI contracted medical care institutions, the obligation of honest report of drugs selling information results from both “Pharmaceutical Benefit Scheme for NHI” and “NHI contract”. For pharmaceutical companies, the obligation of honest report of drugs selling information results from only “Pharmaceutical Benefit Scheme for NHI”. To encourange pharmaceutical companies fulfill the obligation of honest report, the more concrete legal relationship between NHIB and pharmaceutical companies should be established. As drugs suppliers, pharmaceutical companies should be allowed to constitute NHI contract with NHIB just like medical care institutions. By the choice of constituting NHI contract, pharmaceutical companies could voluntarily undertake the harmful obligation of honest report. Pharmaceutical price difference would be elimiated if NHIB implemented “Unitary pharmaceutical procurement”. But the problum of violation of “Fair Trade Act” should be concerned. Implementation of “The separation of drugs prescription and dispensation” will narrow the difference between reimbursed price and market selling price and decrease unreasonable prescription due to the financial profit. Establishment of adequate principles of approval and adjustment of reimbursement prices would be helpful to improve reasonable pharmaceutical trade.The key point to control NHI drugs expense is carrying out an adequate pharmaceutical payment system. Implementation of “Global budget of drugs expense” will successfully control NHI drugs expense in the beforehand reserved range.