臺灣健保體制中藥品給付價格制度之探討

Abstract

本文以訪談調查的方式訪問6位醫藥界的專家學者，探討藥品費用分配比率目標制度(DET)上路後對藥價的影響，以及探討DET執行前後對新藥引進的影響，以及未來的藥價政策可能的改革方向。藥品費用分配比率目標制(DET)隨著二代健保上路後，原想藉由 DET 之設定能預估藥價刪減對相關產業的衝擊，卻因醫療資源投入明顯不足以及執行釋法有偏差之下，雖然每年調整藥價但藥費占全部醫療費用的比例卻下降有限，從2014年的26.44%至2016年的25.93%，僅僅微幅下降0.51%，而醫藥界對其也有頗多意見。本研究綜合專訪專家學者分析後，結論與建議如下： 1.大多數醫藥專家學者大都不同意健保局訂定年度藥費支出目標值(DET)，當超出DET時依目前市場調查資料作調整的作法，顯示應該增加其他的因子，更廣泛的進行探討並修正目前的DET相關機制。另外也都認為DET的執行對於藥價差縮小的部分相當有限。 2.研究顯示專家學者認為DET對新藥的引進影響有限，多數認為藥價差在近幾年下來已日趨穩定，且醫院還是大多使用第一及第二類的藥品，且藥廠在評估效益下，還是會引進具有利基點的藥品。 3.專家學者大多數不同意藥品三合一制度實施後，可以解決目前藥價差的問題，主要問題點在於目前的議價制度以及醫院的回饋制度。 4.在未來改革上，部分專家學者建議可參考加拿大的個人健康基金帳戶，或是在DET繼續實施時應該考慮因人口老化造成的藥費成長原因，基期值應該改依上一年度實際使用額度扣除調降額度，並從各種制度面來減少藥品/醫療檢查等的重複與浪費。

This study interviews six experts and scholars to explore the impact of the Drug Expenditure Target (DET) on the price of drugs, and that of the introduction of new drugs before and after the implementation of DET, and the future drug pricing policy. DET with the second Generation NHI on the road, was originally intended to estimate the impact of drug price balance cuts on relevant industries through the setting of DET. However, it was deferred due to the obvious shortage of medical resources and the implementation of interpretation. In the following, although the annual adjustment of drug prices, the proportion of drug costs in the total medical expenses has decreased by a narrow margin, from 26.44% in 2014 to 25.93% in 2016, only a slight drop of 0.51%. After comprehensive analysis of this study by experts and scholars, the conclusions and recommendations are as follows: 1. Most experts and scholars do not agree with the establishment of the Annual DET by the The National Health Insurance administration. When the market exceeds the DET, adjustments based on current market survey data suggest that other factors should be added for more extensive discussion. In addition, it is also considered that the implementation of DET is quite limited for the narrowing of drug price balance differences. 2. The study shows that experts and scholars believe that the impact of DET on the introduction of new drugs is limited. Most think that the drug price spread has become increasingly stable in recent years, and most hospitals still use the first and second types of drugs, and the pharmaceutical companies are still evaluating the benefits. Drugs with niche points will be introduced. 3. Most experts and scholars disagree with the implementation of the three-in-one drug system, which can solve the current problem of drug price difference. The main problems lie in the current bargaining system and the hospital's feedback system. 4. In terms of future reforms, experts and scholars recommend that reference can be made to Canada's personal health fund account, or that due to the aging of the population due to demographic ageing, consideration should be given to the reasons for the growth of drug costs. The value of the base period should be reduced by the actual amount used in the previous year, and reduce the duplication and waste of medicines/medical examinations from various systems.