日本健保藥費之控制

Drug Price Containment of Health Insurance in Japan

我國與日本都已開辦全民健康保險，全體國民皆可藉由保險獲得醫療上 必須的藥品支付，為了健全健康保險財務，減少經濟之負面效應，有效地控 制藥費支出是刻不容緩。日本厚生省察覺日本醫療費用逐年上升，且超過經 濟成長率，尤其是老人的醫療費用明顯上升，學者認為藥費的增加是造成醫 療費用上升的主要原因之一，所以積極改善藥費的管控，以達到財務平衡的 目標。本研究目的是以日本經驗來擇取其優點以提供我國建立藥價支付制 度。以「制度研究途徑」共五點來分析日本藥品支付制度： （l）健保體制及 營運機構。（2 ）藥品品項，分類及藥政管理。（3 ）收錄藥品支付之程序。 （4 ）藥品價格調查機制。（5 ）健保決定藥品支付價格之程序。日本對於藥費 的控制，主要是藉由「藥價基準表』藥品價格的訂定與改定（藥價調查）方 式，對藥品的價格進行管制，以減低藥價支付來降低藥品費用占全國醫療總 支出的比例，日本一直努力在調整支付價與醫療機構的採購價的藥價差，以 逐年修正藥價基準'降低藥價差，同時以獎金制度鼓勵醫療、製藥產業的研 究，達到維護國民終身健康的目的。所以對保險支付藥品控制其價格，間接 地達成控制藥費成長之目標，可提供我國健保藥費支付的參考。

Health insurance programs have been performed in Taiwan and Japan. The national health insurance was put into effect with the intention of providing benefits for the entire population of the country. Ministry of Health, Labour and Welfare (MHLW) aware that since Japan is becoming a truely aging society, the imbalance between the increase of medical expenditure and the economic growth is getting worse. Consequently, controlling expenditure is an important issue for government to cut down healthcare cost. Therefore, the purpose of this study is to adopt the advantages of Japan's drug reimbursement system to establish a drug price control strategy in Taiwan. The study, via 'systematic research approaches' method to analyze the drug reimbursement in Japan are as follows: (1) health insurance system and operating organization; (2) drug items, classification and pharmaceutical administration management; (3) processes of drug price setting; (4) investigation of the mechanism on market drug price; (5) procedures of drug reimbursement. Besides bonus encouragement in medical and pharmaceutical research, this research indicates that the revolution of drug reimbursement in Japan was gradual, on the basis of eliminating the drug price gap between the hospital purchase cost and the health insurance reimbursement as much as possible. Through study the drug control mechanism in Japan, this study aims to establish a helpful strategy on drug price control in Taiwan.