健康医疗费用总额预算下药品总额的未来趋势.pptx

健康醫療費用總額預算下藥品總額的未來趨勢;支付制度的影響—採購照護;支付制度之比較分析;Terminology of Budget Constrain;總額預算制度之實施背景; A Comparison of Budget Constraint and Methods of Rationing for Selected Countries;總額預算之分類;總額實施對醫界之影響;總額支付下醫療提供者的Prisoners’ Dilemma;;;德國健保的三特色 強制性且自願性的加入疾病基金會 疾病基金會提供的服務包含疾病的預防、疾病的篩檢、診斷性的治療及處置、疾病的治療 疾病基金會及醫療供給者間的協商關係是受到管理;;1977---Health Care Cost Containment Act 1980s---the physician payment system was further amended, to directly control the overall expenditure level. 1987---Expenditure caps were first used 1992---the expenditure cap mechanism was replaced with an expenditure targeting mechanism. ;Global budgeting in Germany :  ;改革的背景;Exhibit 1Annual Growth In Physician Expenditures And Income Per Sickness Fund Member, Western Germany,1985-1993;The 1993 Health Care Reform Act;Expenditure controls on physician services;;以一種15ＤＭ成本價的藥品為例： 製造商出廠價格 → 15ＤＭ 經銷商 ＋ 18％ → 17.70ＤＭ 藥局 ＋ 48％ → 26.20ＤＭ 營業稅＋ 16％ → 30.39ＤＭ 30.39ＤＭ為一般定價，而KK 支付藥局的 價格為30.39ＤＭ×95％＝28.87ＤＭ（折 扣率為5％）。 5.雖然新藥不斷推出，KK 會對每種藥品定 一平均價;German Drug global budgeting;;藥費總額預算是由KV 與KK 兩方協商，並 依社會法典第84 條規定，以下列四種因素 決定總額： （1）保險對象人數及年齡結構的改變 （2）藥品及物理治療價格指數變化 （3）保險給付項目的改變 （4）新藥及新治療方法的改進 同時協商談判中，也須考慮下列成長因 素： （1）學名藥及me- too 藥品因素 （2）重複用藥貢獻率 （3）新藥貢獻率 （4）由醫院移轉到一般門診用藥影響率 （5）有爭議的藥品費用 （6）重病及低收入者的藥品 （7）保險財務的付費能力 ;Expenditure controls on pharmaceutical provision by physicians; Prescribe More than 15% -- economic monitoring More than 25% -- physicians ‘ income will be automatically reduced Setting prices – Reference Price System Prescription drugs Over-the-counter drugs Increasing consumer copayments Past -- on price Now -- on quantity – reduce incentives to consume;;;Expenditure controls on pharmaceutical provision by physicians;醫師費 支出目標---1977-1985,1992 支出上限---1986-1991,1993-1997 1998---個別醫師 支出目標 醫院 支出上限 藥品費 支出上限---1993,1994-1997 支出目標---1998;Reform on Payment-- Abolish global budget in 2006;DRG Payment System;Background of TW-DRG;Basic concept of DRG;診斷關聯群之沿革;Case mix complexity的概念;Hospital Operation