Exploration of the Influences on Price Control of Drug Reimbursement Rate Reduction Policy in Taiwan’s National Health Insurance System--- An Empirical Study on Hypotensive Agents
Date Issued
2008
Date
2008
Author(s)
Chen, Chi-Liang
Abstract
Rapidly rising pharmaceutical costs have been a worldwide problem. Under such pressure, governments in many countries have launched various programs in order to curtail the growth of drug expenditure; among them, drug price control is frequently used. Extant research, however, has used macro-level (aggregate) data and can only provide very limited insights into the effect of the drug price control policy on health care providers’ prescription behaviors. Consequently, these works fall short in examining whether the pharmaceutical price control policy can improve the cost-curative effect of pharmaceutical use, and whether the drug price control policy may have different influences on health care providers with different characteristics. his study investigates influences of Taiwan’s drug reimbursement rate reduction policy in its National Health Insurance system on the price level and the cost-curative effect of pharmaceutical use, using hypertension patients’ usage of hypotensive agents as the example for such analysis. Specifically, we take advantage of the rich content of data in the National Health Insurance Research Database to construct a micro-level database that enables us to examine the following additional two issues: (1) whether the pharmaceutical price control policy has helped improve the cost-curative effect of usage of hypotensive agents, and (2) whether this policy has different effects on health care providers with different characteristics. e used Taiwanese hypertension patients aged 40 or over as our study population. This population accounts for almost the entire population of hypertension patients who take prescription drugs. We selected the two most used narrow classes of hypotensive agents based on the first four digits of the coding system of Anatomical Therapeutic Classification (ATC). They are peripherally acting antiadrenergic agents (ATC code=C02C) and plain angiotensin II antagonists (ATC code=C09C).To provide insights into whether the reimbursement rate reduction policy has had different effects for hospitals with different characteristics, we apply the hierarchical linear modeling (HLM) technique. indings from this study indicate that the price control initiatives between 2000 and 2003 were not helpful for improving the cost-curative effect of using the C02C and the C09C drugs, since the daily expense was not reduced for these two drug classes because of the initiatives. As the magnitude of price reduction level was small for each of the two drug classes, such findings reflect the uselessness of the small price reduction. hile the drug price control policy had insignificant effects on the daily expense for the C02C drugs and the C09C drugs, variations in the influence existed among health care providers with different characteristics. Physicians in public hospitals appeared to prescribe cheaper C09C drugs after the 2000 price reduction. In contrast, physicians in medical centers tended to prescribe more expensive drugs in the two classes after a reimbursement rate reduction action. The percentage of the specialist group comprising cardiologists, nephrologists, and internal medicine physicians in a hospital was associated with a tendency to prescribe more expensive C09C drugs after the 2001 and the 2003 reductions. he different changes in the daily expense after the drug price reductions for hospitals suggest that hospitals with different characteristics might have different patterns of switching drug types in their prescriptions or some patients might switch hospitals after an action of reimbursement rate reduction. Such results suggest a need for the government to better monitor health providers’ behavior of switching prescription drugs and patients’ behavior of switching hospitals so as to have a better understanding with respect to how drug price control actions could affect pharmaceutical expenditures and health care quality.
Subjects
Cost control policy
Drug expenditure
Financial incentive
Health care providers’ behavior
National Health Insurance system
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