title: Urban-rural disparity of generics prescription in Taiwan: the example of dihydropyridine derivatives.
abstract: The aim of the current study was to investigate the urban-rural disparity of prescribing generics, which were usually cheaper than branded drugs, within the universal health insurance system in Taiwan. Data sources were the cohort datasets of National Health Insurance Research Database with claims data in 2010. The generic prescribing ratios of dihydropyridine (DHP) derivatives (the proportion of DHP prescribed as generics to all prescribed DHP) of medical facilities were examined against the urbanization levels of the clinic location. Among the total 21,606,914 defined daily doses of DHP, 35.7% belonged to generics. The aggregate generic prescribing ratio rose from 6.7% at academic medical centers to 15.3% at regional hospitals, 29.4% at community hospital, and 66.1% at physician clinics. Among physician clinics, the generic prescribing ratio in urban areas was 63.9 ± 41.0% (mean ± standard deviation), lower than that in suburban (69.6 ± 38.7%) and in rural (74.1% ± 35.3%). After adjusting the related factors in the linear regression model, generic prescribing ratios of suburban and rural clinics were significantly higher than those of urban clinics (β = 0.043 and 0.077; P = 0.024 and 0.008, resp.). The generic prescribing ratio of the most popular antihypertensive agents at a clinic was reversely associated with the urbanization level.
authors.affiliation: Department of Pharmacy, Taipei Veterans General Hospital, Taipei 11217, Taiwan.
authors.forename: Chia-Chen
authors.identifier: 0000-0001-5218-716X
authors.initials: CC
authors.lastname: Hsu
authors.affiliation: Department of Pharmacy, Taipei Veterans General Hospital, Taipei 11217, Taiwan.
authors.forename: Chia-Lin
authors.identifier: 0000-0001-5751-1037
authors.initials: CL
authors.lastname: Chou
authors.affiliation: School of Medicine, Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei 11221, Taiwan.
authors.forename: Shu-Chiung
authors.initials: SC
authors.lastname: Chiang
authors.affiliation: School of Medicine, Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei 11221, Taiwan ; Department of Family Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan.
authors.forename: Tzeng-Ji
authors.identifier: 0000-0002-8350-0232
authors.initials: TJ
authors.lastname: Chen
authors.affiliation: Department of Public Finance, National Chengchi University, Taipei 11605, Taiwan.
authors.forename: Li-Fang
authors.initials: LF
authors.lastname: Chou
authors.affiliation: Department of Pharmacy, Taipei Veterans General Hospital, Taipei 11217, Taiwan ; Department and Institute of Pharmacology, National Yang-Ming University, Taipei 11221, Taiwan ; College of Pharmacy, Taipei Medical University, Taipei 11031, Taiwan.
authors.forename: Yueh-Ching
authors.identifier: 0000-0001-7191-0974
authors.initials: YC
authors.lastname: Chou
mesh_terms: D002121:Calcium Channel Blockers; D004095:Dihydropyridines; D016568:Drugs, Generic; D054625:Healthcare Disparities; D006801:Humans; D055553:Prescription Drugs; D019035:Rural Health Services; D013624:Taiwan; D019037:Urban Health Services
chemical_list: D002121:Calcium Channel Blockers; D004095:Dihydropyridines; D016568:Drugs, Generic; D055553:Prescription Drugs; C038806:1,4-dihydropyridine