The impact of NHI drug reimbursement adjustment on prescribing pattern and patient outcomes in Taiwan

Presenter: Yiying Lin, NTU, Taiwan

Abstract

Rationale: Health Insurance (NHI) in Taiwan has been launching for 14 years and drug expenditure was about 25% of total health care expenditure. Drug price policy was become an important strategy to control the growth rate of health care expenditure. Since 1995, the Bureau of NHI conducted five times of survey of drug prices and drug reimbursement adjustment. After the drug reimbursement adjustment, many physicians had changed their prescribing patterns in order to gain more profit from drugs. On the other hand, the influence of prescribing behavior on patient outcomes were significant. It's a issue about drug price, incentives, physician behavior and quality of health care.

Objectives: In this study, we want to explore the effect of NHI drug reimbursement adjustment on prescribing pattern and patient outcomes.

Methods: This study used outpatient data of the NHI Research Databases between 2002 and 2005. The outpatient claim data of patients from September of 2oo2 to February of 2003 was used for data analysis. This study was focus on (1) To explore the change of hospitals or physicians prescribing patterns after drug reimbursement adjustment on March 1, 2003 (2) To investigate the effect of drug reimbursement adjustment on patient outcomes. The change of hospitals or physicians prescribing patterns is defined as brand-name drug replaced by generic drug. According to this definition, we compared patient outcomes of two groups (change drugs or not) within six months, one year or two years after drug reimbursement adjustment in 2003. This study selected outpatient visits, outpatient expenditure, inpatient visits and inpatient days etc. to measure patient outcomes and applied the difference-in-difference (DID) approach to conduct this analysis.

Result: The impact of NHI drug reimbursement adjustment was significant on prescribing pattern and patient outcomes. After collecting and analyzing data of this study completely, the results will be presented in the conference.