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 ) .
[Drug prescribing in primary health care for diabetic and non-diabetic patients: effect of therapeutic drug budgeting].
With computerised data on drug prescriptions , which were collected among a sample of 362 internist , general and medical practitioners throughout Germany , the effects of the drug budget , based on the German Health Care Structure Reform Act ( GSG ) , on diabetic patients were analysed . The data of 3053 diabetic patients ( 10 % r and om sample ) were compared with the same number of nondiabetic patients for the period of July 1992 to December 1994 . The frequency of consultations per patient increased in both groups during the study period ( p < 0.01 ) . Diabetic patients had more contacts with the physicians than nondiabetic subjects ( p < 0.01 ) . The prescriptions and costs among the patients with diabetes decreased in the first six month of 1993 ( -10%/ -16 % ) . In the following time costs increased and exceeded the values of 1992 by about 13 % . The costs per prescription decreased during the study period about 10 % . The data show that costs as well as prescriptions per consultation between diabetic and nondiabetic patients remained in the same ratio . The proportion of consultations with > or = 1 prescription increased in diabetic patients after the GSG . A refusal to prescribe drugs in primary health care practice s among diabetic patients was not observed . There was also no restriction on prescription drug use among diabetic patients compared with nondiabetics
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 ) .