Dutch insurance company will pay doctors to prescribe cheap drugs

BMJ 2006; 332 doi: (Published 02 February 2006) Cite this as: BMJ 2006;332:254
  1. Tony Sheldon
  1. Utrecht

    A court in the Netherlands has rejected attempts by doctors and patients' groups to stop a health insurance company offering financial rewards to doctors for prescribing cheap generic versions of statins and proton pump inhibitors.

    The court ruled that the scheme, from Menzis, one of the largest health insurers, does not remove doctors' independence or obligation to make their own choice of which drugs to prescribe. Such choices are based on professional standards to which the doctors must adhere and “there is nothing to show that doctors would deviate from these simply because of the bonus,” it concluded.

    The Dutch Medical Association retains “serious objections” to the scheme, “strongly advising” its members against the scheme, which, it argues, amounts to an “undesirable influence on GPs prescribing behaviour.”

    The Menzis initiative is seen as a test case because the medical profession is concerned that powerful health insurers will seek to influence clinical judgments to reduce costs. Insurers have been accused of “sitting in the doctor's chair.”

    Menzis, based in Groningen, is the market leader in health insurance in parts of the Netherlands. GPs need contracts with Menzis to work in these areas. As part of these contracts, GPs are being invited to join a “rational prescribing module” in which they are financially rewarded for new patients who choose cheaper generic medicines for lowering cholesterol and reducing gastric acidity, such as the statin simvastatin and the proton pump inhibitor omeprazole.

    GPs will receive bonuses for hitting annual targets of up to 85% of new patients choosing simvastatin and 95% of new patients choosing omeprazole. Menzis says average bonuses could amount to €2000 (£1370; $2420) a year, but they stress that this can only be spent on “improvements in GP care.”


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