Chu Hsuan-Lien, Liu Shuen-Zen, Romeis James C
Department of Accounting, College of Commerce, National Taipei University, Taiwan, ROC.
Health Serv Manage Res. 2011 Feb;24(1):1-7. doi: 10.1258/hsmr.2010.010016.
This study investigates the initial effects of the government's prescription drug price reduction policies on outpatient hypertension treatment for the elderly in Taiwan. The National Health Insurance scheme has taken a number of steps in recent years to reduce drug prices. The data used in the study comprises the medical records of approximately 137,000 hypertension patients aged 65 and above. Regression analysis is used to determine whether the average cost of prescription drugs has declined as a result of the policy. In addition, the probit model is used to examine changes in physicians' prescribing behaviour for reduced-price and full-price drugs and the effect of drug substitution on health outcomes. We find that the average cost per prescription increased slightly despite the implementation of the price reduction policies. In addition, we found that physicians do substitute full-price drugs for reduced-price drugs. However, they appear to be reluctant to reduce the use of essential drugs, even when facing rate reductions. The evidence suggests that physicians consider the profit they can derive by prescribing certain drugs; hence, health policy officials should monitor the effects of possible drug substitutions when they design policies for their own countries.
本研究探讨台湾地区政府处方药降价政策对老年门诊高血压治疗的初步影响。近年来，国民健康保险计划已采取多项措施降低药品价格。本研究使用的数据包括约13.7万名65岁及以上高血压患者的病历。回归分析用于确定政策实施后处方药的平均成本是否下降。此外，使用概率模型来检验医生对降价药和全价药的处方行为变化以及药物替代对健康结果的影响。我们发现，尽管实施了降价政策，但每张处方的平均成本仍略有增加。此外，我们发现医生确实会用全价药替代降价药。然而，即使面临降价，他们似乎也不愿意减少基本药物的使用。证据表明，医生会考虑通过开具某些药物所能获得的利润；因此，卫生政策官员在为自己国家设计政策时应监测可能的药物替代所产生的影响。
