Impact of hospital global budget and drug budget payment on hospital medication behaviors：Example of diabetic drug Sulfonyureas

• Main Authors: Yu-Chin Hsu, 徐裕欽
• Other Authors: Herng-Chia Chiu
• Format: Others
• Language: zh-TW
• Published: 2007
• Online Access: http://ndltd.ncl.edu.tw/handle/56961126080409662677

碩士 === 高雄醫學大學 === 醫務管理學研究所碩士在職專班 === 95 === Purpose Since July 1, 2002, the Bureau of National Health Insurance implement the hospital total cost amount system to control the medical expenses and prevent health insurance deficit expanded continually. The medical expense has been risen year by year, the medication cost is the largest expenses of total medication cost. This paper will discuss how to reduce the medication cost, also the hospital total cost amount and medication total cost amount influence hospital medication. Method By using the material of people health insurance from National Health Research Institutes, we apply pre-test and per-test on the discussion. The first part：before implement hospital total cost amount system which from January, 2000 to December,2002; also after implement hospital total cost amount system from January,2003 to December,2005, in which we discuss about the use amount and expense cost influence of import drugs and the domestically produced drugs in the hospital. The second part: before implement hospital total cost amount system which from January, 2000 to December,2004; also after implement hospital total cost amount system from January,2005 to December,2005, in which we discuss about the use amount and expense cost influence of import drugs and the domestically produced drugs in the hospital; later we analyze and discuss the hospital particular; patient character and the relation between use amount and cost. Result A.The influence of before and after the hospital total amount system implementation to import drugs use amount and expense cost 1. After the hospital total amount implementation, both the import drugs and the domestically produced drugs use amount increase. 2. After the hospital total amount implementation, both the imports drugs and the domestically produced drugs expense cost increase. B.The influence of after the hospital drugs use total amount implement to the hospital medication 1. The import drugs use amount reduce but the domestically produced drugs amount of use increased after the hospital drugs use total amount implementation. 2. Both the imports drugs and the domestically produced drugs expense cost increase after the hospital drugs use total amount implementation. C.The influence of patient medication distribution between before and after the hospital total amount system implementation After the hospital total amount implementation, the use amount increase of ages under 44 group, but reduce of both age 45 to 64 years group and age above 65 years group. Three groups show increase of expense cost. D.The relation between hospital particular and both use amount and expense cost 1. The Class： From year 2000 to 2002 and before the hospital total amount implementation, the medical center shows the highest 35.01% annual average declaration quantity; the region hospital shows 33.03%; the local hospital shows 17.71%; and the local clinic shows 14.25%. From year 2003 to 2005, after the hospital total amount implementation, the region hospital shows the highest 33.80% annual average declaration quantity; the medical center shows 33.60%; the local hospital shows 18.18%; and the local clinic shows 14.42%. By above statistics, we find out after hospital total amount system implementation, the annual average declaration quantity of both medical center and the local clinic show reduce; but of both region hospital and local hospital show increase. Also by both while before and after the hospital total amount implementation, the medical center shows the highest 41.71% and 39.81% of average declaration cost. Above four different level medical institutes show increase of the average import drugs use cost the implementation, 2. The District： Before the hospital total amount implementation, the Taipei Branch of Bureau of National Health Insurance with the highest 33.16% average declaration quantity; the Eastern Region Branch of the Bureau of National Health Insurance with the lowest 2.28%. After the hospital total amount implementation, the Taipei Branch of Bureau of National Health Insurance with the highest 35.85% average declaration quantity; the Eastern Region Branch of the Bureau of National Health Insurance with the lowest 2.56%. Before the hospital total amount implementation, the Taipei Branch of Bureau of National Health Insurance with the highest average declaration cost 35.59%; and 39.93% after the implementation. 3. The Authority： Before the hospital total amount implementation, the legal foundation hospital shows the highest 41.18% average declaration quantity, also 41.61% after the implementation. Both public hospital and legal foundation hospital show the average declaration quantity reduce after the implementation, but private hospital shows increase. Before the implementing, the legal foundation hospital show the highest average declaration cost amount 48.19%, and 49.08% after the implementation. All three different authority hospitals show increase of the average declaration cost amount. E.Influence factor of use amount and total cost Include gender、age、hospital level、the sub-bureau of health insurance bureau and the drugs total amount all affect the import medicine use quantity and the cost amount Conclusion and Suggestion After the hospital total amount implementation, the import drugs quantity report drop year by year, but the domestically produced drugs amount grow rapidly. Also after the implementation, the declaration cost amount shows grow of both import and the domestically produced drugs. Year 2005, the National Health Insurance implement the total drug use amount, both the import drug amount declaration and total cost declaration drop down substantially. Which import drug effect the total drug amount of hospital total amount. Cause of the implementation, the domestically produced drugs also substituted for a partial import drugs. From this result, we find out that after the hospital total amount system implementation comprehensively, the average import drug use rate is about 67.87% in both medical center and region hospital. Compare to the scientific medicine, the import drug is more expensive and higher cost. For save medicine resources and prevent expenses lose therefore we suggest the chief organizations should seriously care about the hospital medication use and promote the scientific medicine use.