Background: Global Budget payment system of the National Health Insurance (NHI) of general practitioners (GP) was introduced on July, 2001. To control pharmaceutical expenditures, the Physicians’ Association had decided to adjust downward the flat rate of payment per day of pharmaceutical cost for GP from 35 to 25 New Taiwan Dollar (NTD, conversion factor is about 33:1 $U.S.) on Jan. 2002. However, flat payment rate to the pharmacies (30 NTD/day) has not adjusted accordingly. It created adverse financial incentive for the GP to claim 51 NTD more per three-day prescription (about 13% of the average cost per visit of 382 NTD in 2002), by establishing so called “Gateway-Pharmacy”, a pharmacy, located at gateway, owned and operated by a clinic. Objectives: To understand the prevalence of the “Gateway-Pharmacies” and to explore its impacts on total NHI health care costs and on the pharmacies. Methods: Secondary data analysis was conducted on all NHI pharmacy prescription claim data from 1997 to 2002, obtained from the National Health Research Institutes. About 2.1-31.1 million records per year were cleaned and matched according to pharmacy’s ID. Two indicators were developed to define Gateway-Pharmacy: 1.Concentration rate of the pharmacy (CRP) was calculated by dividing total monthly #prescriptions received from the top clinic which release the prescriptions by total # filled prescriptions of that pharmacy; 2. Concentration rate of the clinic (CRC) was calculated by dividing total monthly #prescriptions received from the top clinic which release the prescriptions by #prescription of that clinic. If both CRP and CRC were greater than 0.9, that pharmacy was defined as Gateway-Pharmacy Result: Of 3,348 NHI contracted pharmacies at end of Dec. 2002; about 30% of them did not receive any prescription. 811 pharmacies, accounted for 24% of total, or almost 10% out of 8,207 clinics, were identified as Gateway-Pharmacies. Their annual prescriptions, around 20 mill
關聯:
優良藥品流通與調劑作業規範國際研討會Good Dispensing and Delivery Practice (GDDP) In
