Abstract
Efficient prescribing is a controversial concept when defined in economic terms. Such terms imply that neither the best nor the cheapest drug may be efficient. Efficiency depends on patient valuations of outcomes — an essential, yet still underdeveloped, field of inquiry. Encouraging prescribing efficiency (once it is clear what efficient treatments are) may require the use of incentives (economic and otherwise). Although physicians do react to economic incentives, encouraging them to also act as good economists rather than only as good healthcare providers may be difficult since economic efficiency goals may conflict with pure medical goals. While it is conceptually reasonable to assume that economic incentives will accomplish behavioural change. other (noneconomic) incentive mechanisms may appear less controversial. Since it is the result, not the process, that is important, a mix of incentives to achieve efficient solutions is suggested. However, further investigation into both health and economic outcomes research and debate on proper efficiency goals should precede the discussion of optimal incentives.
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References
Soumerai SB. Avorn J. Efficacy and cost-containment in hospital pharmacotherapy; state of the art and future directions.Millbank Q 1984; 62 (3): 447–74
Anonymous. ‘Wasteful’ French prescribing. Scrip 1993; 18093
Anonymous. FRG doctors under scrutiny. Scrip 1993: 1843: 7
Anonymous. UK DoH exploring cOst benefit. Scrip 1993: 1823: 2
Detsky AS. Guideline, for economic analysis of pharmaceutical products: a draft document for Ontario and Canada.Pharnaco Economics 1993: 3 (6): 354–61
Anderson LG. Settle RF. Benefit-cost analysis: a practical guide. Lexington: DC Heath & Co,.1977
Schwartz WB. Mendelson DN. Why managed care ca not contain hospital costs without rationing. Commentary. Health Aff 1992: 11 (2): 100–7
Lilja J. How physicians choose their drugs. Soc Sci Med 1976: 10: 363–65
Finkler SA. The distinction between cost and charges. Ann Intern Med 1982: 96: 106–9
Phelps CE. Health economics. New York: HarperCollins Publishers Inc 1992
Pauly MV. The economics of moral hazard. Am Econ Rev 1968: 53 (3): 231–7
Arrow KJ. Uncertainty and the welfare economics of medical care. Am Econ Rev 1963: 53 (5): 941–73
Schelling TC. Choice and consequence. Cambridge: Harvard University Press. 1984
Menzel PT. Strong medicine: the ethical rationing of health care. New York: Oxford University Press. 1990
Drummond ME Stoddart GL. Torrqance GW. Methods for the economic evaluation of health care programmes. New York: Oxford University Press. 1987
Shaw B. The doctor’s dilemma. Baltimore: Penguin Books Inc 1954
Mitchell JM. Sunshine JH. Consequences of physicians’ ownnership of health care facilities–joint ventures in radiationtherapy. N Engl J Med 1992: 327 (21): 1497–501
Reiman AS. ‘self-referral’–what’s at stake? N Engl J Med 1992: 327 (21): 1522–4
Swedlow A. Johnson G. Smithline N. et al.Increased costs and rates of use in the California workers’ compensation systemas a result of self-referral by physicians. N Engl J Med 1992: 327 (21): 1502–6
Wennberg JE, Barnes BA. Zubkof TM. Professional uncertainty and the problem of supplier-induced demand. Soc Sci Med 1982: 16:811–24
Lomas J. Fooks C. Rice T. et al. Paying physicians in Canada: minding our Ps and Qs. Health Aff 1989: 8 (1): 80–102
Avorn J. Chen M. Hartley R. Scientific versus commercial sourceS of influence on the prescribing behavior of physicians. Am J Med 1982: 73: 4–8
Shorter E. Bedside manners: the troubled history of doctors and patients. New York: Simon & Schuster. 1985
Bloomfield Rubins H. From clinical trials to clinical practice: generalizing from participant to patient. Controlled Clin Trials 1994: 15: 7–10
Schroeder SA. Myers LP. McPhee SJ. et al. The failure of physician education as a cost containment strategy: report of a prospective controlled trial at a university hospital. JAMA 1984: 252: 225–30
Avorn J. Soumerai SB. Improving drug-therapy decisions through educational outreach: a randomized controlled trial of academically based ‘detailing’. N Engl J Med 1983: 308 (24): 1457–63
Soumerai SB. Avorn J. Economic and policy analysis of university-based drug ‘detailing’. Med Care: 1986: 24 (4): 313–31
DemsetZ H. Information and efficiency: another viewpoint. J Law Econ 1996: 12: 1–22
Moore WJ. Newman RJ. US Medicaid drug formularies. Do they work? Pharmaco Economics 1992: 1 Suppl. 128–31
Lipsy RJ. Ins~titutional formularies: the relevance of pharmacoeconomic analysis to formulary decisions. Pharmaco Economics 1992: 1 (4): 265–81
Hillman AL. Financial incentives for physicians in HMOs–is there a conflict of interest? N Engl J Med 1987: 317 (27): 1743–48
Lavizzo-Mourey RJ. Eisenberg JM. Prescription drugs. practising physicians. and the elderly. Health Aff 1990: 9 (3): 20–35
Dworkin R. Will Clinton’s plan be fair? N Y Rev Books 1994: 41 (1 & 2:Jan 13): 20–5
Reiman AS. Doctors and the dispensing of drugs. N Engl J Med 1987: 317: 311–12
Reiman AS. Salaried physicians and economic incentives. N Engl J Med 1988: 319 (12): 784
Egdahl RH. Taft CH. Financial incentives to physicians. N Engl J Med 1986: 315 (1):59–61
Rucker TD. Schiff G. Drug formularies: myths information. Med Care 1990: 28 (10): 928–39
Eddy DM. Should we change the rules for evaluating medical technologies? In: Gelijins. editor. Modern methods of clinical investigation. Washington DC: National Academy Press.1990: 117–34
Eisenberg JM. Glick H. Koffer H. Pharmacoeconomics: economic evaluation of pharmaceuticals. In: Strom. editor. Pharmacoepidemiology. New York: Churchill Livingstone. 1989;325-50
Rittenhouse SR. The relevance of searching for effects under a clinical trial lamp post: a key issue. In review
Grabowski H. Health reform and pharmaceutical innovation. Seton Hall Law Rev 1994; 24 (3): 1221–59
Moran DW, Wolfe PR. Can managed care control costs. Health Aff 1991; 10 (4): 120–8
Berensen RA. A physician’s view of managed care. Health Aff 1991; 10 (4): 106–19
Eisenberg JM. Williams Sv. Cost containment and changing physicians’ practice behavior. JAMA 1981: 246 (19): 2195–201
Hillman AL. Commentary: managing the physician: rules versus intentives. Health Aff 1991: 10 (4): 138–46
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Rittenhouse, B.E. Economic Incentives and Disincentives for Efficient Prescribing. Pharmacoeconomics 6, 222–232 (1994). https://doi.org/10.2165/00019053-199406030-00006
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DOI: https://doi.org/10.2165/00019053-199406030-00006