Changes in the prescription pattern of antipsychotics for schizophrenic outpatients after the implementation of a global budgeting program

Hsien Jane Chiu, Po Han Chou, El Wui Loh, Tzuo Yun Lan, Bo Jian Wu, Yung Yan Chang, Shuen Zen Liu, Tsuo Hung Lan

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: A hospital-based global budget (GB) program was implemented by the Taiwan Bureau of National Health Insurance (TBNHI) to control the rising costs of medical care. We investigated whether the introduction of the GB program affected prescriptions for second-generation antipsychotics (SGAs) for schizophrenic outpatients in public and private medical and psychiatric centers. Methods: The prescription data of schizophrenic outpatients treated between 2001 and 2004 were retrieved from the TBNHI database, which included outpatients who were diagnosed as having schizophrenia during the period from 1996 to 2001. Because the new health insurance policy may have had a lag effect on physicians' decision regarding SGA prescription, we used January 2004 as the timepoint to divide the data, which was 6 months after GB implementation. Thus, data from the 6-month period immediately after the GB implementation were included in the pre-GB period. Second-generation antipsychotics included in the study were clozapine, risperidone, olanzapine, quetiapine, ziprasidone, zotepin, and amisulpride. Results: After January 2004, the proportion of SGA use in outpatient departments did not show an upward trend, as had been observed in the pre-GB period, which appeared at a staggering pace lasting for 12 months ( p=0.0004). Compared with medical centers, SGA expenditures in the psychiatric centers were less affected in the GB period ( p<0.0001). Compared to the private sector, the SGA expenditures in the public sector were less affected in the GB period ( p<0.019). Conclusion: We concluded that the GB implementation reduced SGA expenditures significantly. The extent of influence varied among hospitals (i.e., public versus private, medical versus psychiatric centers), which was most likely caused by financial factors.

Original languageEnglish
Pages (from-to)325-332
Number of pages8
JournalJournal of the Chinese Medical Association
Volume77
Issue number6
DOIs
Publication statusPublished - Jun 2014
Externally publishedYes

Fingerprint

Budgets
Antipsychotic Agents
Prescriptions
Outpatients
Health Expenditures
Psychiatry
National Health Programs
olanzapine
Taiwan
Risperidone
Private Sector
Clozapine
Public Sector
Public Hospitals
Health Insurance
Health Policy
Health Care Costs
Schizophrenia
Databases
Physicians

Keywords

  • Global budgeting
  • National Health Insurance
  • Schizophrenia

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Changes in the prescription pattern of antipsychotics for schizophrenic outpatients after the implementation of a global budgeting program. / Chiu, Hsien Jane; Chou, Po Han; Loh, El Wui; Lan, Tzuo Yun; Wu, Bo Jian; Chang, Yung Yan; Liu, Shuen Zen; Lan, Tsuo Hung.

In: Journal of the Chinese Medical Association, Vol. 77, No. 6, 06.2014, p. 325-332.

Research output: Contribution to journalArticle

Chiu, Hsien Jane ; Chou, Po Han ; Loh, El Wui ; Lan, Tzuo Yun ; Wu, Bo Jian ; Chang, Yung Yan ; Liu, Shuen Zen ; Lan, Tsuo Hung. / Changes in the prescription pattern of antipsychotics for schizophrenic outpatients after the implementation of a global budgeting program. In: Journal of the Chinese Medical Association. 2014 ; Vol. 77, No. 6. pp. 325-332.
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abstract = "Background: A hospital-based global budget (GB) program was implemented by the Taiwan Bureau of National Health Insurance (TBNHI) to control the rising costs of medical care. We investigated whether the introduction of the GB program affected prescriptions for second-generation antipsychotics (SGAs) for schizophrenic outpatients in public and private medical and psychiatric centers. Methods: The prescription data of schizophrenic outpatients treated between 2001 and 2004 were retrieved from the TBNHI database, which included outpatients who were diagnosed as having schizophrenia during the period from 1996 to 2001. Because the new health insurance policy may have had a lag effect on physicians' decision regarding SGA prescription, we used January 2004 as the timepoint to divide the data, which was 6 months after GB implementation. Thus, data from the 6-month period immediately after the GB implementation were included in the pre-GB period. Second-generation antipsychotics included in the study were clozapine, risperidone, olanzapine, quetiapine, ziprasidone, zotepin, and amisulpride. Results: After January 2004, the proportion of SGA use in outpatient departments did not show an upward trend, as had been observed in the pre-GB period, which appeared at a staggering pace lasting for 12 months ( p=0.0004). Compared with medical centers, SGA expenditures in the psychiatric centers were less affected in the GB period ( p<0.0001). Compared to the private sector, the SGA expenditures in the public sector were less affected in the GB period ( p<0.019). Conclusion: We concluded that the GB implementation reduced SGA expenditures significantly. The extent of influence varied among hospitals (i.e., public versus private, medical versus psychiatric centers), which was most likely caused by financial factors.",
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AU - Chou, Po Han

AU - Loh, El Wui

AU - Lan, Tzuo Yun

AU - Wu, Bo Jian

AU - Chang, Yung Yan

AU - Liu, Shuen Zen

AU - Lan, Tsuo Hung

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