Although financial incentives are considered an important element in strategies to change prescribing patterns , limited evidence of their effects can be found .
BACKGROUND The proportion of total healthcare expenditures spent on drugs has continued to grow in countries of all income categories .
Policy-makers are under pressure to control pharmaceutical expenditures without adversely affecting quality of care .
Financial incentives seeking to influence prescribers ' behaviour include budgetary arrangements at primary care and hospital setting s ( pharmaceutical budget caps or targets ) , financial rewards for target behaviours or outcomes ( pay for performance interventions ) and reduced benefit margin for prescribers based on medicine sales and prescriptions ( pharmaceutical reimbursement rate reduction policies ) .
This is the first up date of the original version of this review .
OBJECTIVES To determine the effects of pharmaceutical policies using financial incentives to influence prescribers ' practice s on drug use , healthcare utilisation , health outcomes and costs ( expenditures ) .
Understanding the effects of a decentralized budget on physicians' compliance with guidelines for statin prescription – a multilevel methodological approach
Background Official guidelines that promote evidence -based and cost-effective prescribing are of main relevance for obvious reasons . However , to what extent these guidelines are followed and their conditioning factors at different levels of the health care system are still insufficiently known . In January 2004 , a de central ized drug budget was implemented in the county of Scania , Sweden . Focusing on lipid-lowering drugs ( i.e. , statins ) , we evaluated the effect of this intervention across a 25-month period . We expected that increased local economic responsibility would promote prescribing of recommended statins . Methods We performed two separate multilevel regression analyses ; on 110 827 individual prescriptions issued at 136 publicly-administered health care centres ( HCCs ) nested within 14 administrative areas ( HCAs ) , and on 72 012 individual prescriptions issued by 115 privately-administered HCCs . Temporal trends in the prevalence of prescription of recommended statins  were investigated by r and om slope analysis . Differences ( i.e. , variance ) between HCCs and between HCAs were expressed by median odds ratio ( MOR ) . Results After the implementation of the de central ized drug budget , adherence to guidelines increased continuously . At the end of the observation period , however , practice variation remained high . Prescription of recommended statins presented a high degree of clustering within both publicly ( i.e. , MORHCC = 2.18 and MORHCA = 1.31 respectively ) and privately administered facilities ( MORHCC = 3.47 ) . Conclusion A de central ized drug budget seems to promote adherence to guidelines for statin prescription . However , the high practice differences at the end of the observation period may reflect inefficient therapeutic traditions , and indicates that rational statin prescription could be further improved
Although financial incentives are considered an important element in strategies to change prescribing patterns , limited evidence of their effects can be found .
BACKGROUND The proportion of total healthcare expenditures spent on drugs has continued to grow in countries of all income categories .
Policy-makers are under pressure to control pharmaceutical expenditures without adversely affecting quality of care .
Financial incentives seeking to influence prescribers ' behaviour include budgetary arrangements at primary care and hospital setting s ( pharmaceutical budget caps or targets ) , financial rewards for target behaviours or outcomes ( pay for performance interventions ) and reduced benefit margin for prescribers based on medicine sales and prescriptions ( pharmaceutical reimbursement rate reduction policies ) .
This is the first up date of the original version of this review .
OBJECTIVES To determine the effects of pharmaceutical policies using financial incentives to influence prescribers ' practice s on drug use , healthcare utilisation , health outcomes and costs ( expenditures ) .