價格戰之外，醫師用藥決策之表裡考量

Abstract

醫療健康產業中，主要的醫療支出以藥品佔最大宗，根據衛福部於 111 年 1 月 12 日核定健保會所陳報之 111 年度健保總額及其分配之協商結果。依核(決)定結果111 年度健保總額突破 8 千億元，全年經費約 8,095.62億元，相較於110年度核定總額的成長率為3.32%，約增加260億元。其中根據衛生福利部全民健康保險會所彙製之『110 年全民健康保險醫療給付費用總額協商參考指標要覽』，2020年台灣的藥費占醫療費用比率為28.9%。藥物的品質及療效是影響病人治療疾病恢復健康最重要的因素。在台灣的醫療市場中，藥廠、醫師、病人各方立場不同，過往對於醫師處方態樣用藥決策的研究文獻，大多是探討健保總額制度、醫院自主管理、藥價政策、或是針對藥物的療效、藥廠品牌、藥商推廣銷售等等。然而隨著全民健保及相關藥政措施的陸續施行，當醫師面臨環境制度改變、限制與誘因不同時，會引發醫療行為改變。影響同一位醫師藥物採用的決策因素，不必然是永遠都一樣。且醫師一生的職涯路徑選擇中，隨著任職機構的轉換、職務位階的變動、目標的不同等，其個人與醫療環境之間會建構出不同的關係連結．在不同的醫院市場區塊會有不同的考量，有鑑於此，本研究主要在結合醫師的個人社會資本觀點，探討醫師用藥時的內在個人考量因素與總體考量因素，與其社會資本積累的關聯性，以及對用藥決策歷程之影響，提供另一角度之實務建議予藥界管理者做為制定行銷策略與拓展市場佔有率參考。 為探索社會資本的積累對於醫師在藥物採用決策的影響與應用，本研究將針對藥品屬性專業、醫療保健制度構面、社會資本構面、醫師專業訓練歷程構面等，對於醫師在不同職涯歷程中用藥決策之影響程度。歸納後得到的結論如下： (1)不同職務之醫師，其用藥決策考量因素占比及順序不同 (2)不同職務之醫師，其用藥決策表裡考量有正向關係 (3)醫師的社會資本與其用藥決策有高度正向關係

In the healthcare industry, pharmaceuticals account for the largest portion of healthcare expenditure. According to the negotiation results of the Ministry of Health and Welfare's report submitted to the National Health Insurance Administration on January 12, 111th year, the total amount of health insurance for the year 111th has exceeded 800 billion New Taiwan Dollars (NTD). The annual budget is approximately NTD 809.562 billion, representing a growth rate of 3.32% compared to the approved budget for the 110th year, with an increase of around NTD 26 billion. According to the "Reference Guidelines for the Total Negotiated Health Insurance Medical Reimbursement Expenses for the 110th Year" compiled by the Ministry of Health and Welfare's National Health Insurance Administration, pharmaceutical expenses in Taiwan accounted for 28.9% of total medical expenses in 2020. The quality and efficacy of medications are the most important factors affecting patients' treatment and recovery. In Taiwan's healthcare market, pharmaceutical companies, doctors, and patients have different perspectives. Previous research literature on physicians' prescribing patterns and medication decision-making mostly focused on the total health insurance amount system, hospital autonomy management, drug pricing policies, medication efficacy, pharmaceutical brands, and pharmaceutical sales promotion. However, with the implementation of national health insurance and related pharmaceutical policies, when doctors face changes in environmental systems, restrictions, and incentives, it can lead to changes in medical practices. The factors influencing a physician's medication decisions may not always be the same. Moreover, throughout a doctor's career path, different relationships and connections are established between the individual and the healthcare environment, influenced by factors such as changes in employing institutions, shifts in job positions, and varying goals. Different considerations arise in different hospital market segments. In light of this, this study aims to integrate the perspective of a physician's personal social capital to explore the intrinsic personal considerations and overall considerations in medication decision-making, their relationship with social capital accumulation, and their impact on the decision-making process. It aims to provide practical recommendations from a different perspective for pharmaceutical industry managers in formulating marketing strategies and expanding market share.

To explore the impact and application of accumulated social capital on physicians' medication adoption decisions, this study will examine the influences of pharmaceutical attributes expertise, healthcare system dimensions, social capital dimensions, and physicians' professional training history on medication decision-making at different stages of their careers. The following conclusions have been drawn from the synthesis:

(1)Physicians with different positions have different proportions and orders of consideration factors in their medication decisions. (2)Physicians with different positions have a positive relationship between the internal and external considerations in their medication decisions. (3)Physicians’ social capital has a highly positive relationship with their medication decisions.