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 ) .
The effects of fundholding in general practice on prescribing habits three years after introduction of the scheme
Abstract Objectives : To observe changes in prescribing practice that occurred after the introduction of fundholding in first wave practice s and to contrast these with changes occurring in similar nonfundholding practice s. Design : Prospect i ve observational study . Setting : Oxford region fundholding study . Subjects : Eight first wave fundholding practice s and five practice s that were not interested in fundholding in 1990 - 1 , which were similar in terms of practice size , training status , locality , and urban rural mix . Three of the fundholding and none of the non-fundholding practice s were dispensing practice s. Main outcome measures : Changes in prescribing practice as measured by net cost per prescribing unit , cost per item , number of items prescribed , and substitution rates for generic drugs three years after the introduction of fundholding . Data for fundholding practice s were analysed separately according to whether they were dispensing or non-dispensing practice s. Results : Prescribing costs rose by a third or more in all types of practice . The patterns of change observed in this cohort after one year of fundholding were reversed . No evidence existed that fundholding had controlled prescribing costs among non-dispensing fundholders ; costs among dispensing fundholders rose least , but the differences were small compared with the overall increase in costs . Conclusions : Early reports of the effectiveness of  fundholding  in curbing prescribing costs have not been confirmed in this longer term study
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 ) .