Lee Yue-Chune, Huang Kuang-Hua, Huang Yu-Tung
Institute of Health and Welfare Policy, Research Center of Health and Welfare Policy, College of Medicine, National Yang-Ming University, Taiwan, ROC.
Health Policy Plan. 2007 Nov;22(6):427-35. doi: 10.1093/heapol/czm035. Epub 2007 Sep 26.
We investigated whether a 2002 pharmaceutical payment reform policy, which provided adverse incentives, fostered an increase in market share of 'gateway pharmacies' (G-pharmacies--pharmacies owned, operated and located by the same clinics that prescribe medicines); what the financial impact of G-pharmacies to the clinics is; and what factors determine whether a clinic decides to open a G-pharmacy.
Using the database of the National Health Research Institutes, we collected secondary data on all of Taiwan's National Health Insurance prescription claims from pharmacies and clinics between 1997 and 2003. A G-pharmacy was defined as a pharmacy in which more than 70% of the prescriptions it filled came from the same clinic, which prescribed at least 900 prescriptions monthly, more than 70% of which were released to the pharmacy. Trend plot and frequency were used to analyse the distribution of G-pharmacy data. Logistic regression was used to explore what factors determined whether a clinic decided to open a G-pharmacy.
After the 2002 reform, the percentage of total prescriptions filled by G-pharmacies reached 78.71%, the increase in percentage (15.23%) was the highest ever and significant (P < 0.01). The reform's adverse payment incentives resulted in a loss of NT$1.86 billion New Taiwan dollars to all clinics and resulted in a reduction in Taiwan's 2003 fee schedules under the global budget payment system. The decision to establish a G-pharmacy was associated with a clinic's being located in less urbanized areas, being a group practice, having higher patient volumes, being a general practitioner, and being privately owned.
The 2002 reform's adverse incentive fostered a significant increase in the market share of G-pharmacies, and reduced the earnings of clinics which did not own them. It is necessary to break the link between profits from pharmaceutical sales and physician prescribing behaviour to prevent the conflict of interest in how medicines are prescribed.
我们调查了一项于2002年实施的药品支付改革政策，该政策产生了负面激励措施，是否促使“门诊药房”（G药房，即由开药的同一诊所拥有、运营并位于该诊所内的药房）的市场份额增加；G药房对诊所的财务影响是什么；以及哪些因素决定诊所是否决定开设G药房。
利用国家卫生研究院的数据库，我们收集了1997年至2003年台湾地区所有国民健康保险药房和诊所处方索赔的二手数据。G药房被定义为这样一家药房，其超过70%的配药处方来自同一家诊所，该诊所每月至少开具900张处方，其中超过70%的处方发放给该药房。趋势图和频率分析用于分析G药房数据的分布情况。逻辑回归用于探究哪些因素决定诊所是否决定开设G药房。
2002年改革后，G药房所配药的总处方比例达到78.71%，比例增幅（15.23%）为历史最高且具有显著性（P<0.01）。改革的负面支付激励措施导致所有诊所损失新台币18.6亿元，并导致台湾地区2003年全球预算支付系统下的费用表减少。开设G药房的决定与诊所位于城市化程度较低的地区、是团体执业、患者量较高、是全科医生以及为私立诊所有关。
2002年改革的负面激励措施促使G药房的市场份额显著增加，并减少了未拥有G药房的诊所的收入。有必要打破药品销售利润与医生开药行为之间的联系，以防止开药过程中的利益冲突。
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