Facilitating generic prescriptions is one of the effective methods to reduce pharmaceutical expenditures. Physicians, as major decision-maker of healthcare resource use, are considered as in key position determining the effectiveness of this policy. Through literature review, this study identified factors that influence physician’s prescription decisions, including patient’s symptoms, efficacy of alternative medicines, regulations at hospital and within healthcare system and previous experiences. As compared to previous quantitative investigations, this thesis adopted a quantitative approach to examine how physicians choose between branded and generic drugs. A list of questions abstracted from literature review was included in a semi-structured interview. Eight physicians from hospitals and clinics in southern Taiwan were invited to participate in the survey. Interview results suggested that clinical symptoms and drug efficacy, in particular “patient’s symptoms, diagnostic results and drug indications” and “drug’s efficacy and patient’s reaction”, are two major factors that concern physician most during their prescription decision-making. Physicians also appear to take other “external” factors into consideration, such as “NHI reimbursement policy and price regulation”. When physicians were asked about their choice between branded and generic drugs, “diseases per se”, “specialty”, “new patients or not”, “severity”, “whether patients stick to a specific medicine” and “pressure from global budget” were identified as the key determinants in making decisions. Key words: physicians’ prescribing decisions; brand name drugs; generic drugs; qualitative study

推動使用學名藥是降低藥費成本的有效措施之一，措施能否成功實行受到多 方面因素所影響；作為藥物的直接提供者，醫師掌控著處方決策權，在選擇處方 原廠藥或學名藥時醫師必須同時考量眾多因素，其對藥物的看法及態度又將影響 學名藥的使用。通過文獻回顧和總結，醫師處方時將先以藥物的特徵為基礎，再 結合病人的疾病狀況而初步確定處方，此外，醫師與病人、藥商、醫謢人員之間 的互動以及在醫院和醫療系統管制中存在的複雜關係，乃至醫師的個人特徵及行 醫背景等外在因素，都將影響其處方決策。 本研究之目的正是探討影響醫師處方行為的因素，以了解醫師如何在原廠藥 或學名藥之間作處方選擇。又過去有關醫師處方原廠藥或學名藥的研究大多是採 用量化的分析方法，因此本研究將採用質性研究方法，通過與醫師進行實際面談 來挖掘影響醫師處方行為的因素，並討論醫師在決策處方原廠藥或學名藥時的考 量，以獲得醫師個人的主觀感受。藉著此項研究，我們希望理解醫師是如何抉擇 選用原廠藥或是學名藥的處方，分析阻礙醫師處方學名藥的原因，以助改善及優 化‘增加使用學名藥’的政策。 根據訪談結果，台灣醫師進行處方時，將首先考慮病人特徵和藥物特徵兩項 內在因素為基礎，後再結合眾多外在因素的考量而確定其藥物處方類型。內在因 素包括了“病人症狀、診斷結果及藥物適應証”、“藥效和病人的用藥效果”，這是 醫師處方決策過程中最基本、最原始和最重要的考量因素；除此之外，外在因素 如“健保制度與藥物價格考量”也是醫師在一般處方決策過程中會考量到的。針對 選擇原廠藥或學名藥處方時，醫師的考量則變成是“治療疾病的類型”、“專科針 對性”、“病人病情” 、“新舊病人”及“病人對處方的要求或堅持”等因素，又由於 醫院及醫療系統的管制，“健保制度的壓力”是影響醫師選擇原廠藥或學名藥處方 時的重點考量因素。 關鍵詞：醫師處方行為；原廠藥；學名藥；質性研究