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 ) .
Prospective study of trends in referral patterns in fundholding and non-fundholding practices in the Oxford region, 1990-4
Abstract Objective : To compare  outpatient referral patterns in fundholding and non-fundholding practice s before and after the NHS reforms in April 1991 . Design : Prospect i ve collection of data on general practitioners ' referrals to specialist outpatient clinics between June 1990 and January 1994 and detailed comparisons of three phases -- October 1990 to March 1991 ( phase 1 ) , October 1991 to March 1992 ( phase 2 ) , and October 1993 to January 1994 ( phase 3 ) . Setting : 10 first wave fundholding practice s and six non-fundholding practice s in the Oxford region . Subjects : Patients referred to consultant outpatient clinics . Results : NHS referral rates increased in fundholding practice s in phase 2 and phase 3 of the study by 8.1/1000 patients a year ( 95 % confidence interval 5.7 to 10.5 ) , anincrease of 7.5 % from phase 1 ( 107.3/1000 ) to phase 3 ( 115.4/1000 ) . Non-fundholders ' rates increased significantly , by 25.3/1000 patients ( 22.5 - 28.1 ) , an increase of 26.6 % from phase 1 ( 95.0/1000 ) to phase 3 ( 120.3/1000 ) . The fundholders ' referral rates to private clinics decreased by 8.8 % , whereas those from non-fundholding practice s increased by 12.2 % . The proportion of referrals going outside district boundaries did not change significantly . Three of the four practice s entering the third and fourth wave of fundholding increased their referral rates significantly in the year before becoming fundholders . Conclusions : No evidence existed that budgetary pressures caused first wave fundholders to reduce referral rates , although the method of budget allocation may have encouraged general practitioners to inflate their referral rates in the preparatory year . Despite investment in new practice based facilities , no evidence yet exists that fundholdingencourages a shift away from specialist care
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 ) .