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研究生:林佩菁
研究生(外文):Pei-Jing Lin
論文名稱:區域醫療資源與糖尿病藥品市場集中度之探討
論文名稱(外文):The Study of Regional Health Care Resources and Diabetes Drug Market Concentration
指導教授:陳曾基陳曾基引用關係李丞華李丞華引用關係
指導教授(外文):Tzeng-Ji ChenCheng-Hua Lee
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:醫務管理研究所
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2009
畢業學年度:97
語文別:中文
論文頁數:88
中文關鍵詞:糖尿病醫療資源賀芬達指數口服降血糖藥品
外文關鍵詞:diabeteshealth care resourcesHerfindahl-Hirschman indexoral antidiabetic drug
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研究背景:

衛生署自1985年7月起推動醫療網計畫,其重心之一即在建立區域醫療體系,但城鄉之間,醫療資源仍有差距。以醫療資源為觀點,探討區域醫療資源與糖尿病藥品市場之相關程度的研究較為缺乏,因此,本研究以糖尿病藥品為例,對區域醫療資源中影響藥品市場集中度(DDD,Defined Daily Dose和金額)、原開發廠藥品市佔率(DDD、金額)及專利藥品市佔率(DDD、金額)之因子做探討。

研究目的:

研究目的有三,分別依DDD及金額探討:(一)瞭解醫療次區域間糖尿病藥品市場集中度和原開發廠藥品、專利藥品市佔率之現況,(二)探討區域醫療資源中影響糖尿病藥品市場集中度之因子,(三)探討區域醫療資源中影響糖尿病原開發廠藥品市佔率、專利藥品市佔率之因子。

研究方法:

本研究分析單位為醫療網所劃分之63個醫療次區域,視每個醫療次區域為單一目標市場。本研究之藥品為口服降血糖藥品(oral antidiabetic drug, OAD),不包括胰島素製劑、複方藥品與Guar Gum類之藥品,依據成分篩選出健保局有收載之糖尿病藥品代碼,並將同廠牌、同成分、不同劑量、少數不同劑型但都為錠劑類之品項視為同一品項,共136個品項。本研究分別依DDD及金額敘述,其描述性統計以次數分配、平均值和標準差分析;推論性統計以複回歸分析探討區域醫療資源中影響糖尿病藥品市場集中度(HHI, Herfindahl-Hirschman Index)、原開發廠藥品市佔率以及專利藥品市佔率之因子。

研究結果:

1.區域級以上醫院集中在台北、台中、高雄和台南等大都會區。坪烏、成功、大武等三個醫療次區域沒有醫院所開出的藥品醫令,其中大武次區域沒有急性一般病床、原開發廠藥品和專利藥品之醫療資源。研究結果顯示:醫療資源的分佈有集中且不均衡的現象。
2.糖尿病藥品市場集中度DDD方面平均為664.8,最大值為2171.3 (第4個醫療次區域:泰林),最小值為338.5 (第49個醫療次區域:屏東)。糖尿病藥品市場集中度金額方面平均為788.1,最大值為1788.1 (第4個醫療次區域:泰林),最小值為429.5 (第50個醫療次區域:潮州)。
3.原開發廠藥品市佔率DDD方面平均為26.4%,最大值為54.2% (第2個醫療次區域:台北),最小值為0 %(第57個醫療次區域:大武)。原開發廠藥品市佔率金額方面平均為44.8%,最大值為77.7 % (第4個醫療次區域:泰林),最小值為0 %(第57個醫療次區域:大武)。
4.專利藥品市佔率DDD方面平均為5.37%,最大值為13.7% (第34個醫療次區域:台西),最小值為0 %(第36、57個醫療次區域:嘉東、大武)。專利藥品市佔率金額方面平均為17.6 %,最大值為37.58 % (第34個醫療次區域:台西),最小值為0 %(第36、57個醫療次區域:嘉東、大武)。
5.區域醫療資源內,每千人糖尿病藥品門診次數愈多,則糖尿病藥品市場集中度(DDD、金額)會愈低,藥品市場愈競爭。而每千人醫院糖尿病藥品門診次數、每日每千人糖尿病藥品使用量 (DDD)愈多,糖尿病藥品市場集中度(DDD、金額)則愈高,藥品市場愈寡佔。都市化程度較高的醫療次區域,其糖尿病藥品市場集中度(DDD)較低,表示高度都市化之醫療次區域的藥品市場較競爭。低收入戶人口佔率愈高,糖尿病藥品市場集中度(金額)愈高,藥品市場愈寡佔。
6.區域醫療資源內,醫療院所家數及每千人醫院糖尿病藥品門診次數愈多,則原開發廠藥品市佔率(DDD、金額)愈高。都市化程度愈低,原開發廠藥品市佔率(DDD、金額)愈低。

結論:

醫療次區域間,糖尿病藥品市場集中度與其原開發廠藥品市場佔有率皆有分佈不均的情形,其可能原因為區域間大型醫療機構的分佈有集中且不均衡的現象,醫院和診所在藥品的使用上差距頗大,此現象值得後續研究探討。

關鍵字: 糖尿病、醫療資源、賀芬達指數、口服降血糖藥品
Background information:

Department of health, executive yuan of Taiwan, has promoted the plan of medical care network since July, 1985. One of the main goals is to construct the system of regional health care, but there are still some differences in health care resources between cities and counties. From the viewpoint of medical resources, the research exploring the relation of health care resources and diabetes drug market was insufficient. Hence, this study discussed the factors, which affect the concentration ratio of drug market (DDD; defined daily dose and price) and the market share of brand drugs and patent drugs (DDD and price), in regional health care resources.

Purpose of research

There are three goals by DDD and price discussions: (1)to understand the status of the concentration ratio of diabetes drug market and the market share of brand and patent drugs between medical sub-regions, (2)to discuss the factors affecting the concentration ratio of diabetes drug market and (3)to discuss the factors affecting the market share of brand drugs and patent drugs for diabetes.

Research methods:

The analytic units of this study were 63 medical sub-regions divided by the medical care network and each medical sub-region was regarded as single target market. The drugs investigated in this study were oral antidiabetic drug (OAD) except for the drugs of insulin, combination and Guar Gum analogue. They were selected from the bureau of national health insurance according to their components. In addition, the drugs, which possessed the same brand and the same component and a pastille form, were the same item. The total items were 136. This study was described by DDD and price. The descriptive statistics was analyzed by using frequency distribution, mean and standard deviation. The inferential statistics was analyzed by using multiple regression to explore the factors affecting the concentration ratio of diabetes drug market (Herfindahl-Hirschman Index; HHI) and the market share of brand drugs and patent drugs for diabetes.


Research results:

1.Medical center and regional hospitals are centered in cities such as Taipei, Taichung, Kaohsiung and Tainan. Three medical sub-regions, Ping-Wu, Chenggung and Tawu, did not have the doctors’ orders issued by hospitals. Especially, Tawu sub-region did not have the medical resources such as general beds, original brand drugs and brand drugs. The results revealed: the distribution of health care resources was concentrated and unbalanced.
2.For the concentration ratio of diabetes drug market, the DDD had an average of 664.8, a maximum of 2171.3 (the fourth medical sub-region: Tai-Lin) and a minimum of 338.5 (the forty-ninth medical sub-region: Pingtung). For the concentration ratio of diabetes drug market, the price had an average of 788.1, a maximum of 1788.1 (the fourth medical sub-region: Tai-Lin) and a minimum of 429.5 (the fiftieth medical sub-region: Chaujan).
3.For the market share of original brand drugs for diabetes, the DDD had an average of 26.4%, a maximum of 54.2% (the second medical sub-region: Taipei) and a minimum of 0% (the fifty-seventh medical sub-region: Tawu). For the market share of original brand drugs for diabetes, the price had an average of 44.8%, a maximum of 77.7% (the fourth medical sub-region: Tai-Lin) and a minimum of 0% (the fifty-seventh medical sub-region: Tawu).
4.For the market share of brand drugs for diabetes, the DDD had an average of 5.37%, a maximum of 13.7% (the thirty-fourth medical sub-region: Taishi) and a minimum of 0 % (the fifty-sixth and fifty-seventh medical sub-regions: Chiadung and Tawu). For the market share of brand drugs for diabetes, the price had an average of 17.6 %, a maximum of 37.58% (the thirty-fourth medical sub-region: Taishi) and a minimum of 0% (the fifty-sixth and fifty-seventh medical sub-regions: Chiadung and Tawu).
5.For regional medical resources, the number of visits per thousand people for diabetes drug increased and then the concentration ratio of diabetes drug market (DDD and price) decreased. Therefore, the drug market was more competitive. On the other hand, the number of visits per thousand for hospital diabetes drug and diabetes drug utilization per day and thousand people (DDD) increased and then the concentration ratio of diabetes drug market (DDD and price) increased. Therefore, the drug market was more oligopolistic. Besides, the higher degree of urbanization in the medical sub-region would decrease the concentration ratio of diabetes drug market (DDD). This means the drug market in the medical sub-region with the higher degree of urbanization was more competitive. Furthermore, the lower population of low income household would increase the concentration ratio of diabetes drug market (price). This means the drug market was more oligopolistic.
6.For regional medical resources, the number of hospitals and clinics and the number of visits per thousand for hospital diabetes drug increased and then the market share of original brand drugs (DDD and price) increased. Moreover, the lower degree of urbanization in the medical sub-region would decrease the market share of original brand drugs (DDD and price).

Conclusions:

Among medical sub-regions, the distribution of the concentration ratio of diabetes drug market and the market share of original brand drugs for diabetes was unbalanced. The possible reasons were the concentrated and unbalanced distributions of regional medical institutions and differences in drug utilization between hospitals and clinics. This phenomenon is worth being further investigated.

Keywords:
diabetes, health care resources, Herfindahl-Hirschman index, oral antidiabetic drug
目錄
致謝....................................................i
摘要....................................................ii
目錄....................................................vii
表目錄..................................................viii
圖目錄..................................................ix
第一章 緒論.............................................1
第一節 研究動機與背景...................................1
第二節 研究目的.........................................4
第二章 文獻探討.........................................5
第一節 糖尿病之簡介.....................................5
第二節 糖尿病藥品之簡介.................................9
第三節 藥品市場與市場集中度.............................12
第四節 醫療資源.........................................17
第三章 研究方法.........................................20
第一節 研究架構.........................................20
第二節 研究假設.........................................21
第三節 研究對象及材料...................................24
第四節 研究變項及操作型定義.............................29
第五節 統計分析.........................................33
第四章 研究結果.........................................38
第一節 描述性分析.......................................38
第二節 推論性統計.......................................58
第五章 討論.............................................64
第一節 研究結果之討論...................................64
第二節 研究方法之討論...................................67
第三節 研究限制之討論...................................68
第六章 結論與建議.......................................70
第一節 結論.............................................70
第二節 建議.............................................73
參考文獻................................................75


表目錄
表3-1研究資料納入分析之糖尿病藥品.......................28
表3-2藥品屬性之操作型定義...............................29
表3-3自變項操作型定義及資料來源(一).....................30
表3-4自變項操作型定義及資料來源(二).....................31
表3-5依變項操作型定義及資料來源.........................32
表4-1-1區域醫療資源(需求面和供給面)之描述性統計.........45
表4-1-2都市化程度之描述性統計...........................45
表4-1-3糖尿病藥品醫令數、品項數之描述性統計.............46
表4-1-4糖尿病藥品HHI、原開發廠藥市佔率、專利藥市佔率之描述性統計....................................................46
表4-1-5區域醫療資源(需求面)之描述性分析.................47
表4-1-5區域醫療資源(需求面)之描述性分析(續).............48
表4-1-6區域醫療資源(供給面)之描述性分析.................49
表4-1-6區域醫療資源(供給面)之描述性分析(續).............50
表4-1-7糖尿病藥品醫令數、品項數之描述性分析.............51
表4-1-7糖尿病藥品醫令數、品項數之描述性分析(續).........52
表4-1-8糖尿病藥品HHI、原開發廠、專利藥品市佔率之描述性分析......................................................53
表4-1-8糖尿病藥品HHI、原開發廠、專利藥品市佔率之描述性分析(續1 )..................................................54
表4-1-8糖尿病藥品HHI、原開發廠、專利藥品市佔率之描述性分析(續2 )..................................................55
表4-1-8糖尿病藥品HHI、原開發廠、專利藥品市佔率之描述性分析(續3 )..................................................56
表4-1-9糖尿病藥品醫令數、品項數之描述性分析(以分局別為單位).....................................................57
表4-1-10糖尿病藥品HHI、原開發廠、專利藥品市佔率之描述性分析(以分局別為單位)........................................57
表4-1-11原開發廠、專利藥品市佔率之描述性分析(以醫療院所層級別為單位)...............................................57
表4-2-1區域醫療資源對糖尿病藥品之HHI(DDD)之複迴歸分析...58
表4-2-2區域醫療資源對糖尿病藥品之HHI(金額)之複迴歸分析..59
表4-2-3區域醫療資源對糖尿病原開發廠藥品市佔率(DDD)之複迴歸分析......................................................60
表4-2-4區域醫療資源對糖尿病原開發廠藥品市佔率(金額)之複迴歸分析....................................................61
表4-2-5區域醫療資源對糖尿病專利藥品市佔率(DDD)之複迴歸分析......................................................62
表4-2-6區域醫療資源對糖尿病專利藥品市佔率(金額)之複迴歸分析......................................................63



圖目錄
圖3-1研究架構...........................................20
圖3-2資料處理流程.......................................27
Albarran, A. B., Dimmick, J. (1996). Concentration and economics of multiformity in the communication industries. The Journal of Media Economics, 9(4), 41-50.

Boyle J.P, Honeycutt A.A., Narayan K.M. ,et al. (2001). Projections of diabetes burden through 2050 :impact of changing demography and disease prevalence in the U.S . Diabetes Care ,24(11),1936-40.

Cunningham , J.P., Cornelius, L.J.(1995).Access to ambulatory care for American Indians and Alaska Natives; the relative important of personal and community resources . Social Science & Medicine,40(3),393-407.

C-W. Chiang, H-F.Chiu,C-Y.Chen, H-L.Wu and C-Y. Yang .(2006).Trends in the use of oral antidiabetic drugs by outpatients in Taiwan: 1997–2003.Journal of Clinical Pharmacy and Therapeutics ,31, 73–82.

Dong, Y., Gao,W., Nan., H., Yu. H., Li, F. ,Duan,W., et al. (2005).Prevalence of Type 2 diabetes in urban and rural Chinese populations in Qingdao,China . Diabetic Medicin ,22(10),1427-1433.

Dimasi et al.(2003). The price of innovation: new estimates of drug development costs . Journal of Health Economics ,22(2), 151-185.

Eisenberg, R.S.(2001).The shifting Functional Balance of Patents and Drug Regulation . Health Affairs,20(5),119-135.

Gonul , F.F., Carter , F.Petrova, E.and Srinivasan,K.(2001).Promotion of prescription Drug and Its Impact on Physician,s Choice Behavior . Journal of Marketing , 65(July) ,19-90.

Hoskins, C., McFadyen, S., Finn, A. (2004). Media economics –Applying economics to new and traditional media. London: Sage.

King , H., Aubert R.E.,Herman W.H.(1998) .Global burden of diabetes, 1995-2025 : prevalence,numerical estimates,and projections.Diabetes Care ,21(9),1414-31.

Lin T., Chou P., Tsai ST., Lee YC., Tai T.Y.(2004).Predicting factors associated with costs of diabetic patients in Taiwan.Diabetes Research and Clinical Practice, 63,119-125.


Montaguti, E., Kuester, S .and Robertson T.S. (2002). Entry Strategy for Radical Product Innovation:A Conceptual Model and Propositional Inventory. International Journal of Research in Marketing ,19,21-42.

Pepall, L., Richards, D. J., Norman, G. (2005). Industrial organization- Contemporary theory & practice. Ohio: South-Boulevard.

Scherer, F.M.(2000).The pharmaceutical industry ,in Culyer and Newhouse(eds.) Handbook of Health Economics,volume 1B,1297-1336,Amsterdam:Elsevier.

Schere, F. M., Ross, D.(1990). Industrial market structure and economic performance (3rd ed.). Boston: Houghton Mifflin.

The National Institute for Health Care Management Research and Educational Foundation .(2002).A Primer:Generic Drug,Patents and the Pharmaceutical Marketplace.

Uwe E. Reinhardt. (2001). Perspective on the pharmaceutical industry. Health Affairs , 20(5),136-149.

Weiner, J.P., Parente, S.T., Garnick,D.W., Fowles, J.,Lawthers, A.G., Palmer, R.H. (1995). Variation in office-based quality.A claim-based profile of care provided to Medicare patients with diabetes. The Journal Of the American Medical Association, 273(19), 1503-1508.

朱橋麗、薛亞聖、江東亮.(2000).醫師人力供給的多寡是否會影響被保險人的門診利用?-1994年國民醫療保健調查之發現.中華衛誌,19(5),381-388.

江瑞坤、劉鎮嘉、嚴韶宏.(2006).糖尿病口服用藥.基層醫學,21(2),43-47.

李丞華.(2001).我國醫療資源與健康照護可近性之研究-民眾醫療利用之地理差異及其影響因素.行政院衛生署90年度科技研究發展計劃.

李奕慧、尤瑞鴻、項秋梅.(2001).偏遠地區社區醫療照護計畫之評估-花蓮縣秀林鄉之實證研究.台灣衛誌,20(3),216-227.

李玉春、林瑞祥、林金龍(2003)建立全民健保以共同照護模式為基礎的糖尿病人疾病管理計畫之先導研究(第三年) .台北:中央健康保險局研究報告.

李丞華.(2003).從效率面談台灣健康體系的再造.台灣衛誌,22(2), 89-96.

李丞華.(2004).全民健保中醫門診利用率及其影響因素.台灣衛誌,23(2) 100-107.
吳肖琪.(1991). 健康保險與醫療網區域資源對醫療利用之影響.國立台灣大學公共衛生研究所,未出版之博士論文.

沈德昌、嚴兆熊.(2008).第2型糖尿病藥物治療新知.台灣醫界,51(11),22-27.

施欣瑋.(2007).醫院藥品市場結構與新藥Thiazolidinediones市場透之相關性研究.國立陽明大學醫務管理研究所,未出版之碩士論文.

柯舜智、莊春發.(2008). 再探台灣有線電視市場集中度.新聞學研究. (94),149-192.

周碧瑟、董道興、李佳琳、莊紹源、林敬恆、楊南屏.(2002).台灣地區糖尿病流行病學. 台灣衛誌,21(2), 83-97.

洪錦墩.(2004).影響原住民對巡迴醫療及保健服務利用之因素探討-以仁愛鄉為例.台灣衛誌,23(4),324-333.

洪乙禎.(2007). 健保體系下藥品費用分攤制度的分析. 人文及社會科學集刊, 11(4) ,473-504.

洪永泰、莊義利、陳怡如、翁文舜、劉季鑫、梁賡義.(2006).台灣地區鄉鎮市區發展類型應用於大型健康調查抽樣設計之研究.健康管理學刊,4(1),1-22.

翁景民、許書銘、楊君琦.(1999).台灣地區電影映演市場集中度分析.新聞學研究, 59: 1-21.

高淑真、李玉春、黃文鴻、李龍騰. (2006).全民健保糖尿病門診問題處方之分析¬-以北台灣為中心之研究. 台灣衛誌, 25(1), 58-64.

高雅慧.(1998).全民健保門診用藥型態之分析研究.行政院衛生署專題研究計畫.

唐正乾、周昌樺、徐維信、蔡東榮. (2003).糖尿病照護藥物的新發展.內科學誌,14(5),215-223.

陳衍蒨.(2006). 地區醫療資源供給與糖尿病人醫療服務利用型態之相關研究─多層次分析.國立陽明大學衛生福利研究所,未出版之碩士論文.

陳建仁、陳國東.(1997).非胰島素依賴型糖尿病盛行率與危險因子.中華衛誌, 16 (4) , 291-308 .

陳建仁,游山林,白其卉等(2003)台灣地區高血壓,高血糖,高血脂之盛行率調查.
-行政院衛生署國民健康局委託研究計畫.
陳珮青、楊銘欽、江東亮、鄭守夏.(2003).病人跨區住院與醫療區資源分佈之探討.台灣衛誌,22(1) ,27-32.

黃文鴻、羅孔伶、陳柳文.(1998).我國健保藥價與國際藥價比較分析之研究.中華衛誌,17(3),265-272.

游素蘭.(2001).影響台灣地區醫療資源分佈之因素.國立台北大學財政學研究所,未出版之碩士論文

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 , 351-42.

張苙雲、謝幸燕.(1994).就醫流向的長期變遷.中華衛誌,13(1),54-76.

張云孆.(2008).醫療資源對糖尿病患者的診斷率、醫療利用率和醫囑順從率之影響.國立陽明大學醫務管理研究所,未出版之碩士論文.

蔡文惠.(1998).全民健康保險北區分局糖尿病人醫療利用級照護結果.國立陽明大學衛生福利研究所,未出版之碩士論文.

蔡敦浩、徐聯恩.(1999).全民健保與醫藥分業對我國製藥產業的衝擊與影響.行政院衛生署研究計畫.

詹定宇、蔡穎吉.(2004).台灣西藥市場通路發展之縱貫性研究.中國行政評論,13(3),161-184.

賴芳足.(1996).全民健保實施後民眾醫療影響因素之研究.中國醫藥大學醫務管理研究所,未出版之碩士論文.

譚令蒂、洪乙禎、謝啟瑞.(2007).論藥價差.經濟論文叢刊,35(4),451-476.

中央健康保險局(2009),健保用藥品項查詢。
網站:http://www.nhi.gov.tw/inquire/query1.asp?menu=1&menu_id=8&WD_ID=42

行政院內政部統計處(2009) ,內政部統計年報。
網站: http://sowf.moi.gov.tw/stat/year/list.htm

WHO Collaborating Centre for Drug Statistics Methodology(2009), ATC/DDD Index 2009.website:http://www.whocc.no/atcddd/
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1. 柯舜智、莊春發.(2008). 再探台灣有線電視市場集中度.新聞學研究. (94),149-192.
2. 柯舜智、莊春發.(2008). 再探台灣有線電視市場集中度.新聞學研究. (94),149-192.
3. 洪乙禎.(2007). 健保體系下藥品費用分攤制度的分析. 人文及社會科學集刊, 11(4) ,473-504.
4. 洪乙禎.(2007). 健保體系下藥品費用分攤制度的分析. 人文及社會科學集刊, 11(4) ,473-504.
5. 翁景民、許書銘、楊君琦.(1999).台灣地區電影映演市場集中度分析.新聞學研究, 59: 1-21.
6. 翁景民、許書銘、楊君琦.(1999).台灣地區電影映演市場集中度分析.新聞學研究, 59: 1-21.
7. 唐正乾、周昌樺、徐維信、蔡東榮. (2003).糖尿病照護藥物的新發展.內科學誌,14(5),215-223.
8. 唐正乾、周昌樺、徐維信、蔡東榮. (2003).糖尿病照護藥物的新發展.內科學誌,14(5),215-223.
9. 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 , 351-42.
10. 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 , 351-42.
11. 詹定宇、蔡穎吉.(2004).台灣西藥市場通路發展之縱貫性研究.中國行政評論,13(3),161-184.
12. 詹定宇、蔡穎吉.(2004).台灣西藥市場通路發展之縱貫性研究.中國行政評論,13(3),161-184.
13. 譚令蒂、洪乙禎、謝啟瑞.(2007).論藥價差.經濟論文叢刊,35(4),451-476.
14. 譚令蒂、洪乙禎、謝啟瑞.(2007).論藥價差.經濟論文叢刊,35(4),451-476.