全民健康保險總額支付制度下藥品支付政策之探討【本期企劃】 試閱
Discussion of Pharmaceutical Reimbursement Policies Under Global Budget System in Taiwan’s National Health Insurance
全民健康保險實施迄今已逾20年，雖然表面上光鮮亮麗，但因人口的老化與醫療科技的推陳出新，再加上「上限制總額支付」的限制，面臨到前所未有的困境。藥品支付受限於總額，不得不依據藥價調查的結果，每年調降「藥物給付項目及支付標準」，進而造成跨國藥廠紛紛撤離臺灣，新藥納入全民健康保險給付越來越困難及本土藥廠苦撐待變的窘境。本文探討在總額支付制度下的藥品支付法令與政策，同時提出相關的改善建議。
The national health insurance with universal coverage in Taiwan has been implemented for more than twenty years. Although the national health insurance wins a lot of applause from the world, it needs to overcome many difficulties posed by an aging population, technological innovation in medicine, and global budget restriction. Because the global budget system in the health insurance determines the drug dispensing and fee schedule, the Bureau of National Health Insurance is forced to use the results of the drug price survey to reduce the fee schedule every year. This price reduction results make global pharmaceutical companies withdrawing their products from Taiwan and local pharmaceutical companies struggling in the market. This article focuses on the laws and policies for drug payment under the global budget system, and gives recommendations for improvement.
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