全民健康保險自84年開辦以來，採用論量計酬支付制度，造就高就醫頻率，最終造成嚴重的醫藥浪費，而且藥品費用成長逐年上升是全球性共同趨勢，故於87年健保首度面臨財務失衡，入不敷出。在我國醫療保健支出中，藥品費用比率普遍高於其他國家，醫療費用支出大約有25％為藥品費用。因此衛生署及健保局皆針對藥品採行各項藥品政策以為因應，本研究之目的即針對藥品政策及藥品費用進行分析探討。 本研究為次級資料分析，資料來源為89年1月至91年12月中區西醫基層健保申報資料檔。針對藥價調整、西醫基層總額支付制度開辦以及調降西醫基層診所日劑藥費(簡表)支付價格三方面藥品費用消長進行分析。 研究結果顯示，各年度中區西醫基層診所申報之總藥品費用多為負成長；縣市別對藥費申報具有顯著的影響；藥品費用在各科別的申報以不分科為主。由基層之申報藥價趨勢，可知藥價調整直接影響整體藥品花費。另在調降西醫基層診所日劑藥費(簡表)支付價格，對醫療提供者申報藥費的控管具有明顯效果；在調降前後，其每位醫師申報之平均件數、用藥日數、每日藥費、每件藥費，均有統計上的顯著差異性。 在西醫基層總額支付制度開辦前後之短期差異，每位醫師每次申報之平均藥費方面為負成長；而縣市別上，大部分縣市申報藥費亦呈現負成長，可見總額支付制度的實施對藥品費用的控制達到一定程度的影響。 建議健保局及衛生主管機關將西醫基層費用的轉移趨勢予以關注，並對醫療提供者之實際藥品申報內容加以分析與修正，以合理控制藥品花費，減少醫療浪費。 After implementation of national health insurance (NHI) from 1995, the fee-for-service payment method was adopted and caused high utilization rate and medical expenditure growing, therefore, the financial deficit has appeared since 1998 as medication cost increasing rapidly. Medicine cost has taken up 25% of the total medical expense in the NHI in Taiwan, much higher than that the other countries. As a result, Department of Health (DOH) and Bureau of National Health Insurance (BNHI) have adopted various policies to control drug expenditures. The purpose of this study is aimed at analyzing drug policies and the growing medication expenditures. The outpatient medical expenditure data file was employed to compare the changes in medical claims among western primary clinics of central Taiwan from January 2000 to December 2002. The adjustment of medication price, global budget payment system in western primary clinics and reducing the proportion of cost on daily medication was analyzed in this study. The result shows that the total medication expenditure claimed from western primary clinics of central Taiwan dropped sharply. The area of cities is a significant factor influencing the results of medication expenditure. At the type of specialist, medication expenditure claimed from general practitioner mostly. According to the trend of expenditure claims, we know that the adjustment of medication price is significantly influencing the results of the medication expenses trend for primary care clinics, the reducing the proportion of cost on daily medication is significantly influencing the results of medication expenditure controls. Average visits per physician, days of each prescription, medication fee per day and medication per visit are significantly influencing the reducing the proportion of cost on daily medication. At the initial impacts of the global budget payment system, average of medication expenditure per physician decreased. At the area of cities, medication expenditure also decreased. The control of medication expenditure was indeed influenced by the implementation of the global budget payment system. This study suggests that DOH and BNHI need to watch about primary care medication expenditure shifting, analyzing the drugs reimbursing content and modifying the payment prices of drugs. Hopefully to control the medication expenditure and reduce the waste of medical resources.
