Changes in drug utilization following the outpatient prescription drug cost-sharing program - evidence from Taiwan's elderly
Journal
Health Policy
Journal Volume
68
Journal Issue
3
Pages
277-287
Date Issued
2004
Author(s)
Romeis, James C.
DOI
246246/2006111501254658
Abstract
This paper examines changes in drug utilization following Taiwan’s newly implemented National Health Insurance (NHI) outpatient prescription drug cost-sharing program for persons over 65 years old. The study is a hospital outpatient prescription level analysis that adopts a pretest–posttest control group experiment design. Selected measures of outpatient prescription drug utilization are examined for cost-sharing & non cost-sharing groups in cost-sharing periods & pre cost-sharing periods. Additional analyses were conducted comparing older patients with & without chronic diseases & differences for essential & non-essential drugs. Patients over age 65 were drawn from 21 hospitals in the Taipei area using a stratified random sampling method. This paper yields several interesting findings. First, average prescription cost & prescription period increased for both the cost-sharing & non cost-sharing groups. However, the rate of increase was significantly less in the cost-sharing group when compared with the non cost-sharing group. Second, the elderly with non-chronic diseases were more sensitive (i.e., reducing drug utilization) to the drug cost-sharing program when compared with those with chronic diseases. Third, for the elderly with non-chronic diseases average drug cost per prescription experienced a smaller decrease in essential drugs but a moderate increase in non-essential drugs for the cost-sharing group. By contrast, for the non cost-sharing group, average drug cost per prescription increased sharply in non-essential drugs as well as essential drugs. Finally, there was a significant increase in the number of prescriptions as well as drug costs above the upper bound of the cost-sharing schedule. The outpatient drug cost-sharing program implemented by the NHI in Taiwan did not reverse the trend of prescription drug cost increases in hospitals. The significant increase in the number of prescriptions above the upper bound of the cost-sharing schedule implies that the NHI should increase the upper bound. Further analysis needs to evaluate any adverse clinical impact for older patients resulting from policy changes.
Subjects
Outpatient prescription drugs
Drug cost-sharing program
Drug co-payments
Taiwan’s elderly
SDGs
Other Subjects
essential drug; aged; article; chronic disease; drug cost; drug utilization; female; health care cost; health program; hospital; human; male; national health insurance; outpatient care; prescription; Taiwan; Aged; Aged, 80 and over; Chronic Disease; Cost Sharing; Drug Utilization; Drugs, Essential; Female; Health Services for the Aged; Humans; Insurance, Pharmaceutical Services; Male; National Health Programs; Program Evaluation; Taiwan
Type
journal article