Abstract
This research project aims to develop and improve the listing and reimbursement
pricing of drugs under a fixed-fee schedule for line-item drug reimbursements under the
National Health Security Scheme for the fiscal year 2024. It also seeks to simulate and
assess the impacts to provide recommendations for future improvements or developments in
the system, processes, or practices. The study utilizes a research and development approach
through participatory action research, working with the National Health Security Office
(NHSO) on the actual reimbursement system. The project involves three key steps: 1)
determining and revising the drug list and reimbursement prices for the fiscal year 2024, 2)
gathering feedback from service providers on the draft drug list and reimbursement rates, and
3) simulating and evaluating the financial impacts. The draft drug list and reimbursement rates
for the fiscal year 2024 include 3 product categories: commercial products, hospital
preparations, and herbal products. Based on feedback from 27 service providers, the
researcher compiled the comments, revised the list, and finalized the reimbursement prices for
implementation. However, only the commercial product segment was implemented, effective
March 1, 2024, while the implementation of the hospital preparations and herbal products was
postponed due to the budgetary impacts cannot be clearly simulated. This postponement was
necessary due to limitations in the previous year's reimbursement data, particularly the lack of
standardized information regarding units of measure, packaging sizes, and drug item codes,
which need to be addressed before the drug list and reimbursement prices can be fully
implemented. Monitoring of reimbursement data for the first three months after implementation
(March - May 2024) for referred outpatient services, disabled outpatient services, and
emergency outpatient services showed that the overall reimbursement value under the revised
drug list and reimbursement prices was 2.4% lower than the invoiced amount. This compares
to a 4.3% lower reimbursement value under the 2023 fee schedule for the same period.
Continuous monitoring and evaluation are necessary, along with establishing communication
channels for service providers to report issues so that adjustments can be made to the drug
list and reimbursement prices throughout the year. Additionally, it is essential to develop
criteria and improve data standards to enable reimbursement for hospital preparations and
herbal products. Further studies should be conducted to develop a reimbursement mechanism
that accommodates pharmacies, which have different price structures from hospitals.
