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 ) .
Effects of the German 1993 health reform law upon primary care practitioners' individual performance: results from an empirical study in sentinel practices.
An empirical study in Lower Saxony aim ed to investigate any changes in primary care physicians ' diagnostic and therapeutic strategies as a result of Germany 's 1993 health reform act ( known as the Gesundheitsstruktur Gesetz or GSG ) , which included the countrywide implementation of a strict drug budget . A sentinel network consisting of a 37 % sample of 350 r and omly selected doctors ( n = 130 , GPs , general internists ) was established in Lower Saxony . Four cross sectional surveys , each focussing on one group of health problems , were carried out during 1993 . These aim ed to show whether sentinel practice networks are suitable for reporting physicians ' attitudes towards health care cost containment policies and , secondly , changes in physicians ' quantitative and qualitative assessment s of the 1993 reform act during its first year of implementation . Participating physicians reported patient consultations ( n = 3728 ) . St and ardised question naires ascertained sociodemographic variables and major reasons for the patients ' visit . Data on the diagnoses associated with the patient 's main reason for the consultation , the doctor 's assessment of the severity of the problem , and diagnostic and treatment strategies were also recorded . The question naire focussed on changes in therapy made by the physician together with the reasons for these changes . A number of treatment changes made with regard to cost containment were recorded . During the course of 1993 a decrease in reported changes in treatment was noticed . As expected , some doctors recorded a reduction in successful outcomes of treatment and ascribed this to the reform act . Differences between the four surveys with regard to the influence of the health reform act on the frequency of changes in treatment and the physicians ' expectations can not be explained sufficiently by the physicians ' adaptation to the cost containment policies within the year
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 ) .