| Summary: | 碩士 === 義守大學 === 管理學院管理碩士在職專班 === 100 === Since 1998 the income has been smaller than the expenditure appears, among them medicines consume rising from 64 billion in1997 to 1322 billion in 2009. In order to resolve the financial problems, the NHI implemented '' Pharmaceutical Benefit Scheme for National Health Insurance”(PBS) and “Guidelines of price adjustment for National Health Insurance reimbursed drugs” in Mar 30 and Apr 28 of 1999. Allergic rhinitis is a common disease in Taiwan; studies indicated that prevalence increases over time. In Taiwan the prevalence of Allergic rhinitis is about 20%, therefore the expense of the public health resources for allergic rhinitis should be concern. This project aims to investigate the impact of drug reimbursement policies on prescription of brand and generic antihistamine drugs in patients with Allergic rhinitis.
Health care claim data from the National Health Insurance (NHI) program during the period 2002-2009, and the ATC 7-digit coding system of NHI Pharmaceutical Subsidy was used as the interface for analyzing the pharmaceutical claim data. In this study, 260,607 cases with allergic rhinitis analysis and prescription of antihistamine drugs were enrolled and analyses, among them 125,713 cases were female and 134,894 were male (data enrollment from 5 medical centers, BNHI southern and KAO-PING Branch). The analytic tools were Microsoft Excel and SPSS 12.0.
Results indicated that from 2002 to 2009, the visits and prescription of antihistamine due to allergic rhinitis were decrease over time. Speciality analyze indicated that number of male is higher than of woman, age between 37 to 56 yr. The average visit times of patients were higher in private medica center than public center. The affect of Drug Reimbursement Policy on brand and generic antihistamine drugs prescription behavior were significant, of which the prescription quantity and amount of generic antihistamine drugs were increase and of brand antihistamine drugs were decrease over time. Distinguish by type of medical center revealed that private medical center tend to prescription of generic antihistamine drugs, but public medical center tend to prescription of brand antihistamine drugs.
In order to improve the financial problems, several policies were implemented by BNHI, include Global Budget System, drug payment price adjustment and Drug Reimbursement Policy. However, the healthcare quality and therapeutic effect were not considerate when these policies implemented. Thus it makes medical sponsor choose generic drugs to obtain higher discount rate and profit. Although these policies makes the pharmaceutical cost maintain at 25% of total medical budget, but the potential medical expenditure can't be assessed when prescription behavior change. We therefore suggest that, relevant organization should revise these policies to make the medical resources distribution and payment system more reasonable and healthcare quality improvement.
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