Education And Debate

Fortnightly Review: Lessons from international experience in controlling pharmaceutical expenditure II: influencing doctors

BMJ 1996; 312 doi: (Published 15 June 1996) Cite this as: BMJ 1996;312:1525
  1. Karen Bloor, research fellowa,
  2. Nick Freemantle, research fellowb
  1. a Department of Health Sciences and Clinical Evaluation, University of York, York YO1 5DD
  2. b Centre for Health Economics, University of York, York YO1 5DD
  1. Correspondence to: Ms Bloor.
  • Accepted 3 April 1996

This is the second of three papers that review international policies to control spending on drugs and to improve the efficiency of drug use. This paper reviews policies influencing doctors' prescribing of drugs—particularly the use of budgetary restrictions, information and feedback, and guidelines—and evaluates the impact of these policies. Studies evaluating incentive systems are limited, but evidence suggests that providing information on its own will not lead to substantial changes in practice and that more active strategies should be evaluated

In Britain several initiatives have been introduced with the aim of improving the efficiency of general practitioners' prescribing behaviour. These include providing data on prescribing analysis and cost (PACT), indicative prescribing budgets, and general practice fundholding. The impact of these policies on prescribing costs has been inadequately evaluated, but it seems to have been limited.1 Can British policy makers learn from other countries' initiatives?

In this paper we examine the impact of policies aimed at directly influencing doctors' prescribing practice. Details of our literature search are in the first paper in this series.

Budgetary restrictions

In Germany budgetary restrictions were introduced in January 1993 that placed a limit on drug costs. The first DM280m (£130m) spent above this limit is paid for out of physicians' remuneration budgets. It was not anticipated that this would have a dramatic effect on doctors' prescribing as it represented only 1% of their total income from treating patients with statutory health insurance. However, there was an immediate and pronounced drop in the number of prescriptions, from 795 million in 1992 to 712 million in 1993. This was accompanied by a change in the product mix of prescribed drugs, in particular a move to generic substitutes and older established drugs. Spending on drugs in 1993 was 25% lower than in 1992.2 Since then prescriptions have tended …

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