臺灣博碩士論文加值系統

本研究題為「藥品品牌對醫師處方健保藥物行為之探討」，旨在了解台灣健保制度下藥品品牌對醫師處方決策的影響。自1995年全民健保制度實行以來，台灣醫藥產業生態發生深遠變化，健保政策和給付機制的調整導致醫療市場集中化，並影響醫師的臨床決策。
背景顯示，健保政策變動顯著影響藥品市場，尤其是原廠藥與學名藥的競爭。1999年起的藥價調整政策促使製藥公司在價格競爭中求生存，學名藥市場擴大對原開發藥廠構成挑戰。本研究旨在探討醫師在這些政策背景下如何選擇原廠藥與學名藥。
研究集中在五個核心變數：藥品療效、實證醫學、藥廠品牌、藥廠行銷活動及病患反應。通過問卷調查，回收145份有效問卷，最終分析122份。結果顯示，醫師的性別、服務年資、科別和醫院類別對其處方行為有影響。75%的醫師有處方學名藥經驗，醫學中心醫師在藥品療效、實證醫學和行銷活動方面表現突出。

信度分析顯示，使用Likert 5點量表的問卷具高信度（Cronbach's α值均超過0.7）。單因子變異數分析和相關係數分析顯示，各變數間存在顯著交互關係。迴歸分析進一步證實，實證醫學和藥廠品牌顯著影響醫師認為原廠專利藥品質更可靠。
結論如下：
藥品療效是醫師處方決策的主要考量因素，醫師普遍認為原廠專利藥療效高於學名藥。
實證醫學支持在醫師選擇藥品中起關鍵作用，特別是有充分臨床試驗和研究數據支持的情況下。
藥廠品牌和行銷活動顯著影響醫師的處方行為，醫師更傾向選擇品牌信任度高且行銷活動強的藥品。
病患反應亦顯著影響醫師的處方選擇，特別是對原廠藥的正面反應和高滿意度。
本研究建議加強實證醫學的普及和教育，促進藥品資訊透明化，重視病患反饋，以提升學名藥的接受度和促進理性處方行為，從而提高藥物處方效率和效果，滿足病患需求，並提升公共衛生水平。

This study, titled "An Investigation into the Impact of Pharmaceutical Brands on Physicians' Prescribing Behavior under the National Health Insurance System," aims to understand how pharmaceutical brands influence physicians' prescribing decisions within Taiwan's National Health Insurance (NHI) system. Since the implementation of the NHI system in 1995, Taiwan's pharmaceutical industry ecosystem has undergone significant changes. Adjustments in health insurance policies and reimbursement mechanisms have led to market concentration and influenced clinical decisions made by physicians.
Background shows that changes in health insurance policies have significantly affected the pharmaceutical market, especially the competition between branded drugs and generic drugs. The drug price adjustment policy initiated in 1999 has compelled pharmaceutical companies to survive in a competitive pricing environment, with the expansion of the generic drug market posing challenges to original drug manufacturers. This study aims to explore how physicians choose between branded drugs and generic drugs in this policy context.
The research focuses on five core aspects: drug efficacy, evidence-based medicine, pharmaceutical brand, pharmaceutical marketing activities, and patient response. Through a questionnaire survey, 145 valid questionnaires were collected, and 122 were ultimately analyzed. Results indicate that factors such as physicians' gender, years of service, specialty, and type of hospital influence their prescribing behavior. 75% of physicians have experience prescribing generic drugs, with physicians in medical centers demonstrating notable performance in terms of drug efficacy, evidence-based medicine, and marketing activities.
Reliability analysis indicates that the questionnaire using a Likert 5-point scale has high reliability (Cronbach's α values all exceeding 0.7). One-way ANOVA and correlation analysis show significant interactions among various aspects. Regression analysis further confirms that evidence-based medicine and pharmaceutical brands significantly impact physicians' perceptions of the quality and reliability of branded patented drugs.
The conclusions are as follows:
Drug efficacy is the primary consideration in physicians' prescribing decisions, with physicians generally believing that branded patented drugs have higher efficacy than generic drugs.
Evidence-based medicine plays a crucial role in physicians' drug selection, particularly when supported by sufficient clinical trials and research data.
Pharmaceutical brands and marketing activities significantly influence physicians' prescribing behavior, with physicians tending to choose drugs from highly trusted brands with strong marketing activities.
Patient response also significantly affects physicians' prescribing choices, especially the positive responses and high satisfaction levels associated with branded drugs.
This study recommends enhancing the dissemination and education of evidence-based medicine, promoting transparency in pharmaceutical information, and emphasizing patient feedback to improve the acceptance of generic drugs and promote rational prescribing behavior. These strategies will help increase the efficiency and effectiveness of drug prescribing, meet patient needs, and enhance public health standards.

致謝 i
摘要 ii
ABSTRACT iv
目錄 vii
表目錄 ix
圖目錄 x
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 2
第三節 研究流程 3
第二章 文獻探討 5
第一節 原廠藥與學名藥的比較分析 5
第二節 處方之定義與衡量 6
第三節 處方藥之行銷處境 10
第四節 影響醫師選擇藥物之要素 14
第三章 研究方法 17
第一節 研究架構 17
第二節 研究假說 18
第三節 研究對象 19
第四節 研究工具 20
第五節 資料處理 22
第四章 研究結果與討論 24
第一節 問卷調查分析 24
第二節 問卷信度分析 27
第三節 單因子變異數分析及T檢定 30
第四節 相關係數分析 38
第五節 迴歸分析 41
第五章 研究結論與建議 44
第一節研究發現與結論 44
第二節 研究建議 46
參考文獻 48
附錄一 問卷 52

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英文文獻
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網頁資料
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健康醫療（2017）。網電子病歷主動呈現價格會不會影響醫師處方檢驗行為？取自：https://wp.me/p8g2XV-4wn
藥師法。取自：https://law.moj.gov.tw/LawClass/LawAll.aspx?PCode=L0030066
醫師法。取自：https://law.moj.gov.tw/LawClass/LawAll.aspx?pcode=L0020001
World Health Organization （2011）取自：https://www.who.int/publications/i/item/9789241564199