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. 2014 Jun;77(6):325-32.
doi: 10.1016/j.jcma.2014.03.004. Epub 2014 May 24.

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

Hsien-Jane Chiu  1 , Po-Han Chou  2 , El-Wui Loh  3 , Tzuo-Yun Lan  4 , Bo-Jian Wu  5 , Yung-Yan Chang  6 , Shuen-Zen Liu  7 , Tsuo-Hung Lan  8
Affiliations

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

Hsien-Jane Chiu et al. J Chin Med Assoc. 2014 Jun.

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.

Keywords: National Health Insurance; global budgeting; schizophrenia.

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Figures

Fig. 1
Fig. 1
The algorithm of data selection, analysis, and stratification. SGA = second-generation antipsychotic.
Fig. 2
Fig. 2
The trends in the proportion of second-generation antipsychotic expenditures. There was an obvious drop in second-generation antipsychotic (SGA) expenditure in July 2002. We believe the implication of global budgeting (GB) in the psychiatry field at that time may explain the change. Beyond July 2002, the expenditure in psychiatry was excluded from the GB system.
Fig. 3
Fig. 3
The trends in the proportion of second-generation antipsychotic expenditures between medical centers and psychiatric centers in outpatient departments. GB = global budgeting.
Fig. 4
Fig. 4
The trends in the proportion of second-generation antipsychotic expenditures between private sector institutions and public sector institutions in outpatient departments. GB = global budgeting.
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