Prescriber incentive policies

Physician payment system (even salaries can be translated into incentives if their level is adjusted according to criteria such as induced expenses, patient satisfaction and quality of care) 

Prescribing budgets (included or not included in comprehensive budgets England and Germany) NON-COERCIVE  

Formularies and treatment protocols, without economic sanctions or incentives Prescription monitoring (with/without feedback) 

Health expenditure (total or almost total) (England) 

Rationalization of prescription, sometimes merely a supervisory approach 

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In Chapter 9, lecturers V. Ortun Rubio of Pompeu Fabra University and L. Cabiedes Miragaya of the University of Oviedo address the subject of measures intended as a way of influencing prescriber decisions. The authors place special emphasis on analysing prescriber incentive policies, distinguishing between incentives of a financial nature (both coercive and non-coercive) and non-financial incentives (information, training, treatment protocols, monitoring of prescription practices, cost-effectiveness guidelines, interaction with other professionals, pressure from patients and so on). The authors advocate incentive policies based on a combination of financial and non-financial incentives. 

To summarize, it should be highlighted that in general terms the issue of prescribing incentives is approached with a marked lack of consideration of such fundamental concerns as their impact on health, although this aspect is indirectly addressed by non-financial incentives and mixed formulas such as those discussed above. Financial incentives alone appear to lack effectiveness as instruments of pharmaceutical policy. Incentives aimed at prescribers should under no circumstances create a clash of interests between their fees and the quality of the care they provide for their patients, and therefore adjustment must be made in these terms. In turn, we cannot ignore that the effect of this type of mechanism on physicians behaviour will depend on, among other factors, the quality of available information on the aspects taken into consideration in their application. 

This chapter on prescriber incentives brings together various midpoints, all of them difficult to find. One of these midpoints concerns incentives (if there is one distinguishing feature of health care organizations it is the advisability of moderating the power of incentives in order to stop financial considerations from short-circuiting clinical considerations) another concerns the balance between health policy issues and industrial policy ones and a third concerns the influences exerted on prescription by the market, the state and clinical standards (the combination of financial and non-financial incentives). 

Co-payment is an instrument that should not be used on its own. Neither efficiency in drag use nor equity nor the control of pharmaceutical expenditure can rest solely on co-payment. Its effectiveness is reinforced when it is combined with other instruments and incentives. In fact, all European countries combine, in different doses and proportions, multiple instruments that influence the behaviour of the industry, prescribes and patients. It is sufficient to recall that pharmaceutical expenditure is the product of price by quantity, and to consider the enormous international variability of drag prices,35 in order to understand the limitations of co-payment regulation in comparison with other policies that influence prices. Policies aimed at price control can be as effective as co-payment - or more so - for purposes of cost containment. 

Generic drug policies can only be effective if the regulatory policy is appropriate, if doctors, pharmacists and patients fully understand, endorse and embrace the concept, and if positive incentives and rewards are provided. The simple fact that in many countries pharmacists are, as noted above, now permitted to substitute the prescribed brand product by the generic has substantially increased the use of the latter. Overall measures aimed at increasing information and transparency in the market should provide... 

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