臺灣博碩士論文加值系統

研究背景與目的
現今社會人口結構逐漸老化，使慢性疾病人口不斷增加，且在醫療科技的進步下使得藥品費用不斷地上升，藥費平均為總醫療費用的四分之一。目前健保局除了對病人採取部分負擔外，另一方面針對藥品支付制度實施藥價調查，以降低藥價。在藥品費用的成長受到管理的背景，本研究擬探討利用高血壓的原廠藥與學名藥，了解在醫療資訊不對稱的特性下，醫事人員與非醫事人員本身的用藥情形

研究方法
本研究利用國家衛生研究院之全民健康保險研究資料庫，使用2005年承保抽樣歸人檔中2007年100萬人就醫資料。以2007年首次就醫並領有降血壓藥物的紀錄作為分析，研究設計採橫斷性、回溯性之實驗對照組研究，將研究對象分為實驗組及對照組兩組，實驗組為醫事人員、對照組為非醫事人員，以探究醫事人員與非醫事人員是否為傾向原廠藥者的情形有所不同。

研究結果與結論
在邏輯斯迴歸中控制疾病嚴重度、藥品特性與醫療機構特性下，醫事人員為傾向原廠藥者是非醫事人員的2.171倍(OR=2.171，p<0.001)。建議除了加強大家對學名藥的認知，在控制藥費的管理上，衛生主管單位可針對藥品部分負擔中，訂定差額負擔。

Background and Objective : In today’s society, aging has become a major health problem and this is a main reason why the amount of chronic disease patients is increasing recently. Also, as the medical technology is improving, the drug expenses are becoming higher, causing the average of drug expenses to be a quarter of the total medical care expenses. At the present, the Bureau of National Health Insurance (NIH) is not only enforcing the co-payment policy for prescription drugs on medication and health service utilization, they are also scrutinizing the pharmaceutical reimbursement scheme at the same time, in order to reduce the drug price. With the background of management executed on drug expenses, this research aims to study the preference for brand-name drugs and generic drugs of anti-hypertensive drugs among medical professionals and non-medical professionals, under the situation with asymmetric medical information.
Method : The outpatients data from hospitals in year 2007 provided by National Health Insurance Research Database (NHRID) of National Health Research Institutes was used in this research. In this research, among patients having 6 times (or above) of outpatient services, the records of those who visited hospitals for their first time and also received anti-hypertensive drugs, were analyzed. Together with the usage of a cross-sectional,naturally experimently control group design as the study method in this research, of which, the research objects were divided into experimental group referring to medical professionals, and control group referring to
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non-medical professionals, the preference for brand-name drugs among medical
professionals and non-medical professionals was studied.
Results and Conclusion : Applying logistic regression to control severity of illness, drug characteristics and medical care institutions, the preference for brand-name drugs ratio of medical professionals is 2.171, compared with non- medical professionals. (OR=2.171, p&lt;0.001). From the results, this study suggested that not only to enhance the public’s knowledge on generic drugs, the policy makers could also scheme the balance billing to achieve lower drug expenses.

誌謝………………………………………………………………………………i
中文摘要…………………………………………………………………………ii
英文摘要…………………………………………………………………………iii
目錄………………………………………………………………………………v
圖目錄……………………………………………………………………………vii
表目錄…………………………………………………………………………....viii
第一章 緒論…………………………………………………………………….1
第一節 研究背景與動機………………………………………………….1
第二節 研究之重要性…………………………………………………… 2
第三節 研究目的………………………………………………………….3
第二章 文獻探討……………………………………………………………….4
第一節 高血壓…………………………………………………………….4
第二節 原廠藥與學名藥………………………………………………… 8
第三節 藥品政策…………………………………………………………14
第四節 醫療資訊不對稱…………………………………………………16
第三章 研究設計與方法………………………………………………………19
第一節 研究架構…………………………………………………………19
第二節 研究假設…………………………………………………………20
第三節 資料來源與研究對象……………………………………………21
第四節 研究變項與操作型定義…………………………………………23
第五節 資料處理與分析方法……………………………………………25
第四章 研究結果………………………………………………………………29
第一節 描述性統計分析…………………………………………………29
第二節 推論性統計分析…………………………………………………40
第五章 討論……………………………………………………………………48
第一節 假說驗證…………………………………………………………48
第二節 傾向原廠藥者之探討……………………………………………49

v
第三節 研究限制…………………………………………………………52
第六章 結論與建議……………………………………………………………53
第一節 結論………………………………………………………………53
第二節 建議………………………………………………………………54
參考文獻…………………………………………………………………………56
附錄………………………………………………………………………………62　

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