Abstract
When both physicians and pharmacists in Taiwan prescribed and dispensed drugs, many elderly people considered the two types of health care providers more or less synonymous (i.e., close substitutes). Two policies mandated in the 1990s changed this perception: National Health Insurance (NHI), which provides insurance coverage to all citizens, and a separation policy (SP) that forbids physicians from dispensing and pharmacists from prescribing drugs. The author finds that by providing an economic incentive to the previously uninsured elderly, NHI raised the probability that they would visit physicians, relative to their continuously insured counterparts. In particular, some previously uninsured elderly who once only visited pharmacists were more likely to also visit physicians after NHI was implemented. Following this, the SP made it more likely that all elderly patients would only visit physicians and buy drugs from on-site pharmacists hired by physicians—a result different than its policy goal.
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Chang, K. H. (2008). Coverage matters: Impacts of national health insurance on health care utilization and mortality of the previously uninsured elderly in Taiwan. Doctoral dissertation, Department of Economics, Michigan State University.
Chen L., Yip W., Chang M.C., Lin H.S., Lee S.D., Chiu Y.L. et al (2007) The effects of Taiwan’s national health insurance on access and health status of the elderly. Health Economics 16: 223–242
Cheng T.M. (2003) Taiwan’s new national health insurance program: Genesis and experience so far. Health Affairs 22(3): 61–76. doi:10.1377/hlthaff.22.3.61
Cheng S.H., Chiang T.L. (1997) The effect of universal health insurance on health care utilization in Taiwan: Results from a natural experiment. Journal of the American Medical Association 278(2): 89–93. doi:10.1001/jama.278.2.89
Chou Y.J., Yip W.C., Lee C.H., Huang N., Sun Y.P., Chang H.J. (2003) Impact of separating drug prescribing and dispensing on provider behavior: Taiwan’s experience. Health Policy and Planning, 18(3): 316–329. doi:10.1093/heapol/czg038
Hsieh, H. Y. (1999). Institutionalization of medicine production: Interaction of institution, organizational ecology and consumption patterns. Doctoral dissertation, Department of Sociology, National Taiwan University (in Chinese).
Hsieh H.Y. (2003) The impact of chain pharmacy on pharmacists’ professional status. The National Chengchi University Journal of Sociology 35: 109–132 (in Chinese)
Huang K.H., Lee Y.C., Huang Y.T. (2004) Impact of the separation of drug prescribing and dispensing policy on the release rate of prescriptions from clinics. Taiwan Journal of Public Health 23(6): 469–478 (in Chinese)
Kwon S. (2003) Pharmaceutical reform and physician strikes in Korea: Separation of drug prescribing and dispensing. Social Science and Medicine 57: 529–538. doi:10.1016/S0277-9536(02)00378-7
Lee, Y. C., Huang, K. H., & Huang, Y. T. (2007). Adverse pharmaceutical payment incentives and providers’ behavior: The emergence of GP-owned gateway pharmacies in Taiwan. Health Policy and Planning, 22, 427–435. doi:10.1093/heapol/czm035
Park S., Soumerai S.B., Adams A.S., Finkelstein J.A., Jang S., Ross-Degnan D. (2005) Antibiotic use following a Korean national policy to prohibit medication dispensing by physicians. Health Policy and Planning, 20(5): 302–309. doi:10.1093/heapol/czi033
Peabody J.W., Yu J.C., Wang Y.R., Bickel S.R. (1995) Health system reform in the Republic of China: Formulating policy in a market-based health system. Journal of the American Medical Association 273(10): 777–781. doi:10.1001/jama.273.10.777
Unschuld P.U. (1976) The social organization and ecology of medical practice in Taiwan. In: Leslie C. (eds) Asian medical systems: A comparative study. University of California Press, Berkeley and Los Angeles, pp 300–316
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Chang, KH. The healer or the druggist: effects of two health care policies in Taiwan on elderly patients’ choice between physician and pharmacist services. Int J Health Care Finance Econ 9, 137–152 (2009). https://doi.org/10.1007/s10754-009-9059-1
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DOI: https://doi.org/10.1007/s10754-009-9059-1
Keywords
- National health insurance
- Drug prescribing and dispensing
- Taiwan
- Physician visits
- Pharmacy visits
- Elderly