Outpatient drug expenditures and prescription policies for diseases with high cost to the National Health Insurance System in Taiwan

Background and Purpose: The high cost of drugs, particularly those used to treat upper respiratory tract infections, is an increasingly important problem for the National Health Insurance system in Taiwan. This study proposed a new classification scheme for reimbursing drug cost and estimated its impact on expenditures and health care utilization. Methods: Data were obtained from the National Health Research Institutes' year 2000 computer file of the National Health Insurance Academic Research Database in Taiwan. Two factors, were used to classify medications: 1) urgency of medications required; and 2) patient's self-care ability. Results: Among the 10 diseases with the highest number of outpatient department (OPD) visits, 7 were upper respiratory diseases. Acute upper respiratory infections (URIs) and acute nasopharyngitis were the 2 diseases with the highest number of OPD visits. Drug expenditure for acute URIs is about 6% of total expenditure for drugs. Medications suitable for URIs patients' self-care accounted for 42.8% of the total cost of prescribed drugs for these illnesses, and treatment medications unsuitable for patients' self-care accounted for 48.6%. Other medications used for URIs could not be grouped into these categories. The total expenditure for acute nasopharyngitis was about 1.3% of total expenditure for drugs. Medications suitable for self-care,in patients with nasopharyngitis accounted for 51.8% of the total cost of medication prescribed for this illness, and medications,unsuitable for patients' self-care accounted for 36.8%. Conclusions: Reducing the medications suitable for patients' self-care,and enforcing different levels of payment rates, on medication's unsuitable for patients' self-care may reduce the excessive use of OPD drugs, improve the appropriateness of utilization for acute UZIs and the common cold and allow medical resources to be distributed more efficiently.