According to the NHI statistics, primary care clinics prescribed the most antibiotics in Taiwan.  However, the NHI reimbursements for antibiotics through the short form only accounted for 20% of the total NHI-reimbursed antibiotics. Many patients were unaware that their medications contain antibiotics, and failed to follow the doctors’ order to complete the treatment cause.  This has increased the antibiotic resistance.  In the future, there might be no effective treatments for treating infection at all. 

According to the NHIA’s publication about the data from the cloud-based medical records, there is a big gap between the NHI reimbursement claims and the actual drug usage in clinics.  Taking fluoroquinolones for example, the best-selling product in this category between 2015 and 2017 was ofloxacin 200mg, of which 64 million tablets were sold.  Among them, 43 million tablets (67%) were prescribed by clinics.  However, the NHI reimbursements data in the past three years told a different story.   The primary care clinics only accounted for a small share of the reimbursement (23%).

Dr Lee Po-Chang, Director General of the NHIA, pointed out that the NHIA pays a fixed amount of drug reimbursement per short form to clinics without further assessment; and this practice has created a medication management loophole, which accelerates the process of antibiotic resistance as warned by healthcare professionals.

This leads to the question about whether the short form system should be abolished.  Dr Lee expressed that the NHIA will continue discussing with the medical groups.  As for the drug resistance problem, Dr Lee pointed out that the public need to be educated about the use of antibiotics; the medical societies need to provide treatment guidance; and the application of new antibiotics should be reviewed by infectious disease physicians. 

Many countries have implemented measures to encourage drug companies to engage in the development of new treatments for infectious diseases.  For example, the NHS and the NICE in the UK are piloting the concept of pre-payment for antibiotics.  It’s like a subscription service.  The insurer pre-pays drug companies for their R&D services.  The US FDA is also working on the measures for monitoring and subsidizing the R&D of new antibiotics.  Dr Lee Po-Chang expressed that the health authority in Taiwan so far has not yet drawn up any similar measures because they require a long-term planning.

【2019-12-10 / United Daily News】