title: Changes in the prescription pattern of antipsychotics for schizophrenic outpatients after the implementation of a global budgeting program.
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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Min-Sheng General Hospital, Taoyuan, Taiwan, ROC.
authors.forename: Hsien-Jane
authors.initials: HJ
authors.lastname: Chiu
authors.affiliation: Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.
authors.forename: Po-Han
authors.initials: PH
authors.lastname: Chou
authors.affiliation: Herbacee International Company Limited, Taoyuan, Taiwan, ROC.
authors.forename: El-Wui
authors.initials: el-W
authors.lastname: Loh
authors.affiliation: Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan, ROC.
authors.forename: Tzuo-Yun
authors.initials: TY
authors.lastname: Lan
authors.affiliation: Department of Psychiatry, Yuli Hospital, Hualien, Taiwan, ROC.
authors.forename: Bo-Jian
authors.initials: BJ
authors.lastname: Wu
authors.affiliation: Division of Mental Health and Addiction Medicine, Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan, ROC; Institute of Public Health and Department of Public Health, National Yang-Ming University, Taipei, Taiwan, ROC.
authors.forename: Yung-Yan
authors.initials: YY
authors.lastname: Chang
authors.affiliation: Department of Accounting, National Taiwan University, Taipei, Taiwan, ROC.
authors.forename: Shuen-Zen
authors.initials: SZ
authors.lastname: Liu
authors.affiliation: Department of Psychiatry, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan, ROC. Electronic address: lonelymanym@yahoo.com.tw.
authors.forename: Tsuo-Hung
authors.initials: TH
authors.lastname: Lan
mesh_terms: D014150:Antipsychotic Agents / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D009313:National Health Programs / Q000331:legislation & jurisprudence*; D010045:Outpatients; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012559:Schizophrenia / Q000188:drug therapy*
chemical_list: D014150:Antipsychotic Agents
keywords: National Health Insurance; global budgeting; schizophrenia