政大機構典藏-National Chengchi University Institutional Repository(NCCUR):Item 140.119/152396

政大機構典藏-National Chengchi University Institutional Repository(NCCUR):Item 140.119/152396

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政大典藏 > College of Commerce > Department of International Business > Theses > Item 140.119/152396

Please use this identifier to cite or link to this item: https://nccur.lib.nccu.edu.tw/handle/140.119/152396

Title:	藥品差額自付政策效果初探 The effect of medicine balance-billing policy
Authors:	楊珵鈜 Yang, Cheng-Hong
Contributors:	溫偉任潘振宇 Wen, Wei-Jen Pan, Chen-Yu 楊珵鈜 Yang, Cheng-Hong
Keywords:	差額自付健保藥價學名藥原廠藥垂直產品差異 Copayment Balance-billing Health insurance drug prices Generic drugs Branded drug Vertical product differentiation
Date:	2024
Issue Date:	2024-08-05 11:56:45 (UTC+8)
Abstract:	我國全民健康保險制度開辦以來，慢性疾病人口數逐年增加、且政府持續引進罕見疾病新藥，導致健保支出項目中「藥費比例」不斷擴大。隨著外國原廠藥專利過期，我國藥廠開始生產學名藥，因學名藥上市審查過程不需進行昂貴的臨床試驗，因此學名藥成本較低，價格亦較為低廉。學名藥加入市場的結果通常會驅使該品項核定藥價下修，原廠藥利潤下滑。為維持我國藥品多樣性，部分國內醫師、藥師等第一線醫護同仁建議應引進藥品差額自付機制，賦予民眾用藥自主權。當民眾選擇健保學名藥時，無須支付差額負擔；而如果民眾主動要求醫師開立原廠藥時，則政府只會補助該品項核定藥價，差額部分民眾需自行加價補貼，即回歸使用者付費的機制。本研究結果發現，政府可透過調整消費者共付額比率，使原廠藥廠有更大生存空間，且不同的參數設定之下，政府可介入調整的空間有所差異。透過社會福利分析，發現政府介入市場維持原廠存活的雙占市場社會福利會大於學名藥獨佔市場。同時，本文推導出學名藥品質與原廠藥利潤非單調關係。最後，本文建議藥品部分負擔政策應考慮不同適應症，根據其原廠藥與學名藥的品質差異，訂定不同的藥品部分負擔率。 Since the establishment of the National Health Insurance (NHI) system in Taiwan, the number of people with chronic diseases is climbing annually. In the meanwhile, government continuously introducing new drugs for rare diseases. As a result, the proportion of medicine expense in NHI budget continuously expanding now. After the patents for branded drugs are expired, domestic generic drugs companies are able to produce generic drugs. Because generic drugs are not required to do expensive clinical trials for selling license, their costs and prices are relatively low. The introduction of generic drugs usually drives down the approved prices of the branded drugs, leading to a decline in the profits of the branded drugs companies. To maintain the diversity of medicines, some healthcare professionals, including doctors and pharmacists, suggest introducing balance-billing mechanism to give patients more autonomy in their medication choices. When patients choose NHI-covered generic drugs, they do not need to pay any extra balance-billing expense. However, if patients request doctors to prescribe branded drug, the government will only subsidize the approved price of the indication, and the patients will need to cover the bills of balance-billing, thereby returning to use-to-pay mechanism. Our research found that the government can adjust the copayment rate to provide greater environment for the existence of branded drugs companies. The power to which the government can intervene varies under different parameter settings. Still, by social welfare analysis, we found that government intervention to maintain the existence of branded drugs in a duopoly market results in greater social welfare than a monopoly market dominated by generic drugs. Furthermore, our study deduced a non-monotonic relationship between the quality of generic drugs and the profits of branded drug companies. Finally, our study suggests that the copayment rate policy for drugs should consider different indications and set different copayment rates based on the quality differences between branded and generic drugs.
Reference:	王宗曦 2022 「從就醫權保障論藥品差額負擔之可行性」 https://www.slideshare.net/slideshow/1110418-251674066/251674066 衛生福利部中央健康保險署最後瀏覽日期： 2023 年 12 月 17 日。何建志（ 2022 「藥品差額負擔與就醫權保障」 https://www.slideshare.net/hprc_tmu/1110418-251674134 台北醫學大學最後瀏覽日期： 2023 年 12 月 17 日。辛炳隆、薛立敏、周麗芳、盧瑞芬、邱文達 1999）），「全民健保部分負擔新制之評估」 13-88 中華經濟研究院。程馨、謝啟瑞 2005 「全民健保藥品政策與藥品費用的經濟分析」《經社法制論叢》 1 42 行政院經濟建設委員會。賴辛癸、藍忠孚（ 1993 「差額負擔：公平、效率與醫療品質間之衝突」，《中華民國公共衛生學會雜誌》，，107-120 台灣公共衛生學會。譚令蒂、洪乙禎、謝啟瑞 2005 「論藥價差」 27-40 中央研究院經濟研究所。 Bronnenberg, B. J. P. Dube , M. Gentzkow and J. M. Shapiro (2015), “Do Pharmacists Buy Bayer? Informed Shoppers and the Branded Premium,” The Quarterly Journal of Economics, 130(4), 1669-1726. Cavaliere, A., Crea, G. (2022), “Branded premia driven by perceived vertical differentiation in markets with information disparity and optimistic consumers”, Journal of Economics, 135(3), 223-253. Cavaliere, A., & Moayedizadeh, A. (2022), “Competition between Generic and Branded Name Drugs: New Evidence from the US Pharmaceutical Market,” University of Pavia, Department of Economics and Management, DEM Working Paper Series , 209. Colgan, S., Faasse, K., Martin, L. R., Stephens, M. H., Grey, A., & Petrie, K. J. (2015), “Perceptions of generic medication in the general population, doctors and pharmacists: a systematic review,” BMJ open , 5(12), e008915. Dunne, S. S., & Dunne, C. P. (2015), “What do people really think of generic medicines? A systematic review and critical appraisal of literature on stakeholder perceptions of generic drugs,” BMC medicine, 13(1), 1-27. Ekelund, Mats and Bjorn Persson (2003), “Pharmaceutical pricing in a regulated market,” Review of Economics and Statistics, 85:2, 298－306. Frank, R. G., & Salkever, D. S. (1992), “Pricing, patent loss and the market for pharmaceuticals,” Southern Economic Journal , 59(2), 165-180. Frank, R. G., & Salkever, D. S. (1997), “Generic entry and the pricing of pharmaceuticals,” Journal of Economics & Management Strategy , 6(1), 75-90. Grabowski, Henry G. and John M. Vernon (1992), “Branded loyalty, entry, and price competition in pharmaceuticals after the 1984 drug act,” Journal of Law and Economics, 35, 331－350. Kesselheim, A. Misono and W. Shrank. (2009), “Equivalence of Generic and Branded-Name Drugs for Cardiovascular Disease Reply,” Journal of the American Medical Association, 301(16), 1654- 1656. LeLorier, J., Duh, M.S., Paradis, P.E., Lefebvre, P., Weiner, J., Manjunath, R., Sheehy, O. (2008), “Clinical Consequences of Generic Substitution of Lamotrigine for Patients with Epilepsy,” Contemporary Issues in Neurological Practice, 70, 2179 - 2186. Nabin, Munirul Haque, Mohan, Vijay, Nicholas, Aaron and Sgro, Pasquale (2012), “Therapeutic equivalence and the generic competition paradox,” B.E. Journal of economic analysis and policy, 1(12), 1-26. Scherer, F. M. (1993), “Pricing, profits, and technological progress in the pharmaceutical industry,” Journal of Economic Perspectives, 7(3), 97-115. Scherer, F.M. (2000), “The pharmaceutical industry, in Culyer and Newhouse ed,” Handbook of Health Economics, Amsterdam: Elsevier, 1297－1336. Vandoros S. and P. Kanavos (2013), “The Generics Paradox revisited: Empirical Evidence from Regulated Markets,” Applied Economics, 48(22), pp. 3230-3239. Wiggins, S. N., & Maness, R. (2004), “Price competition in pharmaceuticals: the case of antiinfectives,” Economic Inquiry, 42(2), 247-263.
Description:	碩士國立政治大學國際經營與貿易學系 111351019
Source URI:	http://thesis.lib.nccu.edu.tw/record/#G0111351019
Data Type:	thesis
Appears in Collections:	[Department of International Business] Theses

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