The impact of physician-level drug budgets on prescribing behavior
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To contain pharmaceutical spending, drug budgets have been introduced across health systems. Apart from analyzing whether drug budgets fulfill their overall goal of reducing spending, changes in the cost and quality of prescribing and the enforcement mechanisms put in place need evaluation to assess the effectiveness of drug budgets at the physician level. In this study, we aim to analyze the cost and quality of prescribing conditional on the level of utilization of the drug budget and in view of varying levels of enforcement in cases of overspending. We observed drug budget utilization in a panel of 440 physicians in three federal states of Germany from 2005 to 2011. At the physician level, we retrospectively calculated drug budgets, the level of drug budget utilization, and differentiated by varying levels of enforcement where physicians overspent their budgets (i.e., more than 115/125% of the drug budget). Using lagged dependent-variable regression models, we analyzed whether the level of drug budget utilization in the previous year affected current prescribing in terms of various indicators to describe the cost and quality of prescribing. We controlled for patient and physician characteristics. The mean drug budget utilization is 92.3%. The level of drug budget utilization influences selected dimensions of cost and quality of prescribing (i.e., generic share (estimate 0.000215; p = 0.0246), concentration of generic brands (estimate 0.000585; p = 0.0056) and therapeutic substances (estimate −0.000060; p < 0.0001) and the share of potentially inappropriate medicines in the elderly (estimate 0.001; p < 0.0001)), whereas the level of enforcement does not. Physicians seem to gradually adjust their prescription patterns, especially in terms of generic substitution.
KeywordsMarket regulation Cost of prescribing Physicians Pharmaceuticals
JEL ClassificationI11 (Analysis of Health Care Markets)
Funding: This study was supported by a research grant from the Federal Ministry of Education and Research in Germany (grant number BMBF 01EH1101A).
Compliance with ethical standards
Conflict of interest
There is no conflict of interest.
- 1.OECD: Health at a Glance 2015: OECD Indicators. OECD Publishing, Paris (2015)Google Scholar
- 2.OECD: OECD Health Data: Pharmaceutical market, http://stats.oecd.org/BrandedView.aspx?oecd_bv_id=health-data-en&doi=data-00545-en. Accessed 9 June 2015
- 4.Vogler, S., Habl, C., Leopold, C., Rosian-Schikuta, I., de Joncheere, K., Thomsen, T.L.: Pharmaceutical pricing and reimbursement information report (PPRI)—Comparative Report. European Commission, DG Health and Consumer Protection, and Austrian Federal Ministry of Health, Family and Youth, Vienna (2008)Google Scholar
- 5.Vogler, S., Schmickl, B.: Rational use of medicines in Europe. Gesundheit Österreich GmbH, Vienna (2010)Google Scholar
- 9.Rashidian, A., Omidvari, A.-H., Vali, Y., Sturm, H., Oxman, A.D.: Pharmaceutical policies: effects of financial incentives for prescribers. In: Cochrane database of systematic reviews. Wiley, Chichester (2015)Google Scholar
- 10.Sturm, H., Austvoll-Dahlgren, A., Aaserud, M., Oxman, A.D., Ramsay, C.R., Vernby, Å., Kösters, J.P.: Pharmaceutical policies: effects of financial incentives for prescribers. In: The Cochrane Collaboration (ed.) Cochrane database of systematic reviews. Wiley, Chichester (2007)Google Scholar
- 12.Corney, R.H., Kerrison, S.: Fundholding in the south Thames Region. Br J Gen Pr. 47, 553–556 (1997)Google Scholar
- 18.Whynes, D.K., Baines, D.L., Tolley, K.H.: GP fundholding and the costs of prescribing. J. Public Health. 17, 323–329 (1995)Google Scholar
- 29.Thiem, U.: Potenziell inadäquate Medikation. Internist. 1125–1130 (2012)Google Scholar
- 34.Blankart, C.R., Stargardt, T.: Preferred supplier contracts in post-patent prescription drug markets. Health Care Manag. Sci. 1–14 (2016)Google Scholar
- 35.Schwabe, P.D. med U.: Arzneiverordnungen 2012 im Überblick [An overview of pharmaceutical prescriptions in 2012]. In: Schwabe, P.D. med U. and Paffrath, D. rer soc D. (eds.) Arzneiverordnungs-Report 2013 [Pharmaceutical prescriptions report 2013]. pp. 3–46. Springer Berlin Heidelberg (2013)Google Scholar
- 38.KVB: Arzneimittelvereinbarung nach §84 Abs.1 SGB V für das Jahr 2014 zwischen der Kassenärztlichen Vereinigung Bayerns und den Krankenkassenverbänden [Agreement according to social code book §84 Abs.1 SGB V for the Bavarian physician association and sickness fund associations for 2014], https://www.kvb.de/verordnungen/arzneimittel/richtliniengesetze/, (2014). Accessed 12 Nov 2014