Liu Ya-Ming, Ou Huang-Tz, Yang Yen-Kuang
No.1 University Road, National Chen Kung University, Tainan 701, Taiwan,
J Ment Health Policy Econ. 2014 Dec;17(4):163-72.
A health care system in which there is no separation between prescription and dispensation, combined with a regulated prescription drug market, leads to various generic substitution mechanisms for antidepressants.
We investigated the determinants of generic versus brand-name antidepressant choices in a regulated prescription market where physicians both prescribe and dispense drugs.
Using data from a sample of one million individuals selected randomly from the registry of National Health Insurance beneficiaries in 2010, and all claims for these one million enrollees between January 1997 and December 2011, we employed logistic regression to examine the choice of generic versus brand-name antidepressants in the Taiwanese prescription drug market.
Access to various antidepressant brands varies according to the accreditation level and type of ownership of the healthcare provider. Private healthcare providers and those with lower accreditation levels were more likely to prescribe generic antidepressants compared to their brand-name counterparts. The diversity of products and competition in the molecule market was positively associated with the probability of prescribing generic antidepressants.
In a regulated prescription drug market with no separation between prescription and dispensation, the substitution of generic antidepressant prescriptions in place of brand-name prescriptions is likely driven by drug and provider market characteristics, rather than by lowering costs.
The allocation of different types of ownership and accreditation levels of healthcare providers may lead to unequal access to various brands of antidepressants.
Policies for improving the treatment of depression should take into account the structure of molecule and provider markets as important factors in determining the choice and utilization of antidepressants, in a healthcare system where physicians both prescribe and dispense drugs.
Other psychotropic drug classes should be investigated to explore the effect of molecule and provider characteristics on the utilization of various classes of medication.
在一个处方与配药不分离且处方药市场受到监管的医疗体系中，会产生各种抗抑郁药的通用名替代机制。
我们调查了在一个医生既开处方又配药的受监管处方药市场中，选择通用名抗抑郁药而非品牌抗抑郁药的决定因素。
利用从2010年国民健康保险受益登记册中随机抽取的100万个人的样本数据，以及这100万参保人在1997年1月至2011年12月期间的所有理赔数据，我们采用逻辑回归分析来研究台湾处方药市场中通用名抗抑郁药与品牌抗抑郁药的选择情况。
获得各种抗抑郁药品牌的机会因医疗服务提供者的认证水平和所有制类型而异。与品牌抗抑郁药相比，私立医疗服务提供者和认证水平较低的提供者更有可能开具通用名抗抑郁药。分子市场中的产品多样性和竞争与开具通用名抗抑郁药的可能性呈正相关。
在一个处方与配药不分离的受监管处方药市场中，用通用名抗抑郁药处方替代品牌处方的行为可能是由药品和提供者市场特征驱动的，而非成本降低。
医疗服务提供者不同所有制类型和认证水平的分配可能导致获得各种品牌抗抑郁药的机会不平等。
在一个医生既开处方又配药的医疗体系中，改善抑郁症治疗的政策应将分子和提供者市场结构作为决定抗抑郁药选择和使用的重要因素加以考虑。
应研究其他精神药物类别，以探索分子和提供者特征对各类药物使用的影响。
