由於台灣健保制度的財務缺口，一些高單價的原廠藥品銷售量明顯受到影響，外商藥廠由於其產品健保價較高並利潤低於國產藥廠，在總額制度限制之下，不利在診所推廣，而診所經營者也對於藥品選擇的考慮因素也越趨成本考量，基於上述原因，本研究希望能探討總額支付制度對於診所選擇輝瑞藥品的影響。

本研究就內科、家醫科、婦產科、小兒科、骨科五種科別診所，考慮邊際效益理論後，架構迴歸模型，並對上述五科別診所各20家發放問卷，彙整其問卷結果後，使用統計軟體進行迴歸分析，探討健保總額制度與不同科別診所對於輝瑞藥品選擇影響。

根據實證結果，本研究發現診所平均每人每日藥費與診所價量齊揚情況兩變數為顯著且與應變數有負向關係，表示基層健保審核指標對診所選擇輝瑞藥品意願具影響；在不同科別的虛擬變數中，受訪診所為婦產科為顯著且與應變數有正向關係，顯示在看診人數逐漸下滑的婦產科，診所醫生較易選擇使用輝瑞藥品來吸引病患就診；診所期望每日看診人數增加也對診所選擇輝瑞藥廠產品有顯著且正向關係。

Owing to the financial weakness of Taiwan’s health insurance system, sales of high priced medicine has declined significantly. In particular, international suppliers, like Pfizer, are finding it very hard to promote the sale of medicine to local clinics in Taiwan because of the higher unit price and lower profit, compared to local manufacturers of medicine.
For the above reasons, this study investigates the relationship of a global budget payment system to the decisions made by local clinics to choose international branded medicine (such as Pfizer); different clinics which are investigated serve as a variable in this study too.
This study considers 5 clinics: Internal medicine, Family medicine, Obstetrics and Gynecology, Pediatric and Orthopedics and builds up the regression model based on marginal utility theories. After delivering the questionnaires to above five clinics and summarizing the results of those questionnaires, we uses regression analysis to study the important factors of a “global budget payment system”.
After evidential analysis, we found 2 significant factors revealed: the average medicine expense of a clinic per day and “Price-Volume Relation”; a negative correlation was revealed in regard to correspondent variable. This means that the “Health Care Performance Index” is an important factor for clinics in deciding whether to choose Pfizer medicine. Looking into different medical areas, we found that Obstetrics/Gynecology has a positive relationship to the correspondent variable; this means that choosing a global famous medicine, like Pfizer, is an effective means for a doctor to attract patients. The expected amount of patients was also proportional to the amount of Pfizer medicine chosen in this clinic.

中文參考文獻
1. 鍾國彪(1997)，「全民健康保險的整體醫療品質之評估計畫」，中央健保局計劃編DOH86-NH-019，台北，中央健保局。
2. 周麗芳、陳曾基(1999)。探究健康保險總額預算制度。台灣醫界，42(2)，57-64。
3. 賴宗成(2000)，醫藥行銷，商業周刊出版股份有限公司。
4. 盧瑞芬、謝啟瑞(2000)，醫療經濟學，194-200，學富文化事業公司，台北市，台灣
5. 張虎生(2002)，實施門診合理量對醫院門診量及對門診診查費影響之研究：以南區健保局之區域醫院為例，成功大學高階管理碩士在職專班碩士論文
6. 張益誠、廖宏恩(2002)，西醫基層診所實施總額預算前後之價量變化以臺灣北部地區西醫基層診所為例，臺灣公共衛生雜誌，21 卷5 期，2002 年10 月，頁363-372
7. 陳欽賢、劉彩卿、林建仁、朱子斌、邱文達(2003)，總額支付制度下醫院同儕行為之競合：賽局理論分析，醫務管理期刊，第4 卷第3 期，2003 年，頁68-79。
8. 陳耀東(2004)，全民健保不同支付制度對醫師執業行為之影響及比較，管理學報，第21 卷第2 期，頁237-255
9. 陳美美(2005)，總額支付制度實施後醫師處方型態改變，健保局94 年委託研究計畫
10. 張育嘉、黎伊帆、汪芳國、鄭守夏(2006)，全民健保實施總額預算制度之初步影響評估：以牙醫與西醫基層為例，臺灣公共衛生雜誌，25 卷2 期，2006年4 月，頁152-162
11. 徐裕欽(2006)，醫院總額和醫院藥品總額對醫院用藥之影響－以Sulfonylureas降血糖藥為例，高雄醫學大學醫務管理學研究所碩士在職專班
12. 陳佩甄(2006)，健保藥品給付價格對門診口服降血糖藥品處方型的影響：以南區健保局之區域醫院為例，成功大學臨床藥學研究所碩士論文
13. 許碩芬、楊雅玲(2007)，醫療提供者之行為策略-賽局理論之應用，管理學報，第24 卷第6 期，2007 年，頁657-670。
14. 許碩芬、楊雅玲、陳和全(2007)，社會困境？─全民健保總額預算制度下醫療提供者策略的均衡分析，管理學報，第24 卷第2 期，2007 年，頁155-166。
15. 柯慈儀、張民忠譯， James R.McGuigan.R.Charles Moyer.freaderick H.deB.Harris著，管理經濟學，華泰出版社，2006年
16. 中華民國醫師公會全國聯合會（2008）。2007年台灣地區執業醫師‧醫療機構統計。中華民國醫師公會全國聯合會編印
17. 醫藥產業年鑑(2008)
18. 中央健保局，總額支付制度意涵，www.nhi.gov.tw/webdata/AttachFiles/Attach_10900_1_8.1：總額支付制度意涵.doc
19. 中央健保局(2009) 西醫基層診所分級管理指標與抽樣審查原則
20. 中央健保局(2009) 全民健康保險基層總額支付審查醫師管理要點
相關網站:
1. ITIS智網:http://www.itis.org.tw/
2. 中央健康保險局:http://www.nhi.gov.tw/
3. IMS:http://imshealth.com

英文參考文獻
1. Hurley J. and Card R. (1996), “Global Physician Budget As Common-Property Resources: Some implications for Physicians and Medical Association”, Canadian Medical Association Journal, 154 (8), 15th April 1996, 1161-1168
2. Creyer, Elizabeth H., and Ilias Hrsistodoulakis (1998), “ Marketing Pharmaceutical Products to Physicians,” Marketing Health Services, Summer, pp. 34-38.
3. Fan, C.P., Chen K.P. and Kan K. (1998), “The Design of Payment System for Physicians under Global Budget--An Experimental Study”, Journal of Economic Behavior & Organization, Vol. 34 (2), 15th February 1998, 295-311
4. Hellerstein, Judith K. (1998),“The Important of the Physician in the Generic Versus Trade-Name Prescription Decision,” RAND Journal of Economics, Vol. 29, No. 1, pp. 108-136.
5. Physicians under Global Budget--An Experimental Study”, Journal of Economic Behavior & Organization, Vol. 34 (2), 15th February 1998, 295-311
6. Griffith, David (1999),“Reasons for Not Seeing Drug Representatives,” British Medical Journal, Vol. 319, July, pp. 69-70.
7. Rizzo JA. (1999). Advertising and Competition in the Ethical Pharmaceutical Industry: the Case of Antihypertensive Drugs. Journal of Law and Economics, vol:42 Iss:1 pp. 89.
8. Tenery, Robert M. (2000),“Interactions Between Physicians and the Health Care Technology Industry,” The Journal of the American Medicine Association,Vol. 283, No. 3, January, pp. 391-93.
9. Wazana, Ashley (2000), “Physicians and the Pharmaceutical Industry: Is a Gift Ever Just a Gift?” The Journal of the American Medicine Association, Vol.283, No. 3, January, pp. 373-80.
10. Goodman, Bob (2001),“Do Drug Company Promotions Influence Physician Behavior?” Western Journal of Medicine, Vol. 274, April, pp. 232-33.
11. Gonul, Fusun F.,Franklin Carter, Elina Petrova and Kannan rinivasan (2001),“Promotion of Prescription Drugs and Its Impact on Physicians` Choice Behavior”, Journal of Marketing, Vol. 65, July, pp. 79-90.
12. Mougeot M. and Naegelen F. (2005), “Hospital price regulation and expenditure cap policy”, Journal of Health Economics, Vol. 24 (1), January 2005, 55-72.
13. Benstetter F. and Wambach F. (2006), “The treadmill effect in a fixed budget system”,Journal of Health Economics, Vol. 25 (1), January 2006, 146-169
14. Windmeijera F., Laat E. Douven R. and Mot E. (2006). Pharmaceutical Promotion and GP Prescription Behaviour. Health Economics, 15: 5-18.