研究背景
藥品價格的成長、數量的成長及剩餘值（residual）的改變帶動了藥品費用的成長，由目前的研究發現「健保給付與否」、「價格利潤空間」及「比價結果」仍是醫療院所選擇引進藥品的重要考量因素。慢性疾病中的糖尿病，其發生率及盛行率正在快速的增加中，且糖尿病患醫療支出佔台灣醫療相當高的比重，平均每位糖尿病患的醫療費用支出較非糖尿病患為高，並且，目前控制糖尿病仍以口服降血糖藥品佔最大比例。因此本研究選取口服降血糖藥品之處方行為作為觀察之代理變數。

研究目的
探討在「全民健康保險藥價基準」及「全民康保險藥品支付價格調整作業要點」規範下，藥品給付價格對口服降血糖藥品中原廠藥品與學名藥品處方分布情形的影響。

研究方法
利用電腦系統以特定變項將全民健康保險學術資料庫（承保抽樣歸人檔）86-93年各檔案資料串聯，使用Microsoft Excel及 SAS For Windows 9.1版套裝軟體執行統計分析。進行描述性統計（descriptive analysis）及推論性統計（inferential statistics）之複迴歸模型分析自變項及控制變項與應變項之關係。

研究結果
結果顯示糖尿病患人數及就診次數逐年增加，使用降血糖藥品人數佔診斷為糖尿病患之人數比例亦逐年成長，由民國86年的61.17%上升至民國93年的75.81%，其中約有13%的病患使用胰島素，96%的病患使用口服降血糖藥品。醫院層級（醫學中心、區域醫院、地區醫院）使用的口服降血糖藥品中，原廠藥品之用藥頻次及總耗用量佔有比例較學名藥品高，且具統計之顯著性；基層院所則以使用學名藥品為主。複迴歸分析結果顯示隨藥品價格調降時，學名藥品的使用機會增加，各類口服降血糖藥品每人日耗用劑量均隨藥品價格降低而增加。醫院權屬別及評鑑等級均會影響原廠藥品與學名藥品的選擇，公立醫療院所、醫學中心、區域醫院較私立醫療院所、地區醫院傾向使用原廠藥品，而基層院所較地區醫院不傾向使用原廠藥品。總額預算實施後，醫療院所則較不傾向使用原廠藥品；總額支付制度實施後，以整體藥品而言，醫學中心、區域醫院及地區醫院每人日耗用劑量有增加的情形，基層院所則呈現耗用量降低的情形。

結論
本研究結果顯示：ㄧ、原廠藥品與學名藥品之處方型態有差異，醫院層級（醫學中心、區域醫院及地區醫院）中，原廠藥品之處方頻次及處方耗用量佔有比例均高於學名藥品，基層院所則以使用學名藥品為主。不論醫院評鑑等級，原廠藥品之每人日耗用量高於學名藥品。二、健保給付價格的確會影響口服降血糖藥品的處方型態，包含原廠藥品、學名藥品的處方選擇及處方耗用量。隨藥品給付價格調降，使用學名藥品的機會增加，原廠藥品及學名藥品的耗用量會隨給付價格調降而增加。

Background
Changes in drug expenditure can be divided into 3 components: the prices of drugs, the quantity of drugs consumed and a residual. The size of the residual is a measure of the effect of changes in drug treatment patterns on drug expenditure. Recent empirical studies suggested that the health-care organizations consider “whether National Health Insurance reimburses or not”, “the profit margin from pharmaceutical reimbursement”, and “price comparison” as the priority in pharmaceutical purchasing. No matter what accreditation level would be, health-care organizations tended to select the medicine with higher price. The prevalence and incidence of diabetes mellitus are all increasing which thus pose significant burden on the health care system. The proportion of medical expenditure for diabetes mellitus to total medical expenditure was high, especially among the ambulatory care. And the mean medical expenditure for one diabetes mellitus patient was higher than that for non-diabetes mellitus. To control diabetes mellitus, most patients were treated with oral hypoglycemic agents (OHAs). Therefore, the prescribing patterns of OHAs were selected as the study subject.
Objective
To estimate the relationship between reimbursement price and prescribing patterns of brand and generic OHAs under the pharmaceutical reimbursement scheme of National Health Insurance.
Methods
The health care claim data from the National Health Insurance (NHI) program during the period 1997-2004 was included for analysis. Microsoft Excel and SAS package software were used for data analysis. And, the relationship among the independent variable, controlled variables and the dependent variable was examined by descriptive analysis and inferential statistics.
Results
The patient number and frequency for medical consultations of diabetes mellitus were increasing during the study period. Nearly, all the diabetic patients were treated with hypoglycemic agents: 13% of those patients took insulin, and 96% patients took OHAs. In medical centers, metropolitan hospitals, and local community hospitals, the proportion of brand pharmaceuticals prescription frequency to total OHAs and the proportion of brand pharmaceuticals consumption to total OHAs were higher than those of generic pharmaceuticals. Drug utilization in primary clinics was mainly generic pharmaceuticals. The results of multivariance regression analysis showed that health-care organizations tended to use generic pharmaceuticals when NHI reimbursement price had been decreased. The lower the reimbursement price, the more quantity the health-care organizations had consumed. Public hospitals, medical centers, and metropolitan hospitals tended to use more brand pharmaceuticals, while primary clinics did not. After implementing the Global Budget, health-care organizations did not tend to prescribe brand-name pharmaceuticals, and the quantity per day per patient all increased in medical centers, metropolitan hospitals, and local community hospitals, but it decreased in primary clinics.
Conclusion
First, there was difference in the OHAs utilization between brand- and generic pharmaceuticals. In medical centers, metropolitan hospitals, and local community hospitals, the proportion of brand pharmaceuticals prescription frequency and consumption to total OHAs were higher than generic pharmaceuticals. Drug utilization in primary clinics was mainly generic pharmaceuticals. No matter what accreditation level of health-care organizations would be, quantity per day per patient of brand pharmaceuticals was higher than generic pharmaceuticals. Secondly, NHI reimbursement price indeed affected drug utilization of oral hypoglycemic agents. When NHI reimbursement price had been decreased, health-care organizations tended to use more generic pharmaceuticals. The lower the reimbursement price, the more quantity the health-care organizations had consumed.

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