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Economic Incentives and Disincentives for Efficient Prescribing

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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

  1. 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

    CAS  Google Scholar 

  2. Anonymous. ‘Wasteful’ French prescribing. Scrip 1993; 18093

    Google Scholar 

  3. Anonymous. FRG doctors under scrutiny. Scrip 1993: 1843: 7

    Google Scholar 

  4. Anonymous. UK DoH exploring cOst benefit. Scrip 1993: 1823: 2

    Google Scholar 

  5. Detsky AS. Guideline, for economic analysis of pharmaceutical products: a draft document for Ontario and Canada.Pharnaco Economics 1993: 3 (6): 354–61

    Article  CAS  Google Scholar 

  6. Anderson LG. Settle RF. Benefit-cost analysis: a practical guide. Lexington: DC Heath & Co,.1977

    Google Scholar 

  7. Schwartz WB. Mendelson DN. Why managed care ca not contain hospital costs without rationing. Commentary. Health Aff 1992: 11 (2): 100–7

    Article  CAS  Google Scholar 

  8. Lilja J. How physicians choose their drugs. Soc Sci Med 1976: 10: 363–65

    Article  PubMed  CAS  Google Scholar 

  9. Finkler SA. The distinction between cost and charges. Ann Intern Med 1982: 96: 106–9

    Google Scholar 

  10. Phelps CE. Health economics. New York: HarperCollins Publishers Inc 1992

    Google Scholar 

  11. Pauly MV. The economics of moral hazard. Am Econ Rev 1968: 53 (3): 231–7

    Google Scholar 

  12. Arrow KJ. Uncertainty and the welfare economics of medical care. Am Econ Rev 1963: 53 (5): 941–73

    Google Scholar 

  13. Schelling TC. Choice and consequence. Cambridge: Harvard University Press. 1984

    Google Scholar 

  14. Menzel PT. Strong medicine: the ethical rationing of health care. New York: Oxford University Press. 1990

    Google Scholar 

  15. Drummond ME Stoddart GL. Torrqance GW. Methods for the economic evaluation of health care programmes. New York: Oxford University Press. 1987

    Google Scholar 

  16. Shaw B. The doctor’s dilemma. Baltimore: Penguin Books Inc 1954

    Google Scholar 

  17. 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

    Article  PubMed  CAS  Google Scholar 

  18. Reiman AS. ‘self-referral’–what’s at stake? N Engl J Med 1992: 327 (21): 1522–4

    Article  Google Scholar 

  19. 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

    Article  PubMed  CAS  Google Scholar 

  20. Wennberg JE, Barnes BA. Zubkof TM. Professional uncertainty and the problem of supplier-induced demand. Soc Sci Med 1982: 16:811–24

    Article  PubMed  CAS  Google Scholar 

  21. Lomas J. Fooks C. Rice T. et al. Paying physicians in Canada: minding our Ps and Qs. Health Aff 1989: 8 (1): 80–102

    Article  CAS  Google Scholar 

  22. 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

    Article  PubMed  CAS  Google Scholar 

  23. Shorter E. Bedside manners: the troubled history of doctors and patients. New York: Simon & Schuster. 1985

    Google Scholar 

  24. Bloomfield Rubins H. From clinical trials to clinical practice: generalizing from participant to patient. Controlled Clin Trials 1994: 15: 7–10

    Article  Google Scholar 

  25. 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

    Article  PubMed  CAS  Google Scholar 

  26. 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

    Article  PubMed  CAS  Google Scholar 

  27. Soumerai SB. Avorn J. Economic and policy analysis of university-based drug ‘detailing’. Med Care: 1986: 24 (4): 313–31

    Article  PubMed  CAS  Google Scholar 

  28. DemsetZ H. Information and efficiency: another viewpoint. J Law Econ 1996: 12: 1–22

    Article  Google Scholar 

  29. Moore WJ. Newman RJ. US Medicaid drug formularies. Do they work? Pharmaco Economics 1992: 1 Suppl. 128–31

    Google Scholar 

  30. Lipsy RJ. Ins~titutional formularies: the relevance of pharmacoeconomic analysis to formulary decisions. Pharmaco Economics 1992: 1 (4): 265–81

    Article  CAS  Google Scholar 

  31. Hillman AL. Financial incentives for physicians in HMOs–is there a conflict of interest? N Engl J Med 1987: 317 (27): 1743–48

    Article  PubMed  CAS  Google Scholar 

  32. Lavizzo-Mourey RJ. Eisenberg JM. Prescription drugs. practising physicians. and the elderly. Health Aff 1990: 9 (3): 20–35

    Article  CAS  Google Scholar 

  33. Dworkin R. Will Clinton’s plan be fair? N Y Rev Books 1994: 41 (1 & 2:Jan 13): 20–5

    Google Scholar 

  34. Reiman AS. Doctors and the dispensing of drugs. N Engl J Med 1987: 317: 311–12

    Article  Google Scholar 

  35. Reiman AS. Salaried physicians and economic incentives. N Engl J Med 1988: 319 (12): 784

    Article  Google Scholar 

  36. Egdahl RH. Taft CH. Financial incentives to physicians. N Engl J Med 1986: 315 (1):59–61

    Article  PubMed  CAS  Google Scholar 

  37. Rucker TD. Schiff G. Drug formularies: myths information. Med Care 1990: 28 (10): 928–39

    Article  PubMed  CAS  Google Scholar 

  38. 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

    Google Scholar 

  39. Eisenberg JM. Glick H. Koffer H. Pharmacoeconomics: economic evaluation of pharmaceuticals. In: Strom. editor. Pharmacoepidemiology. New York: Churchill Livingstone. 1989;325-50

    Google Scholar 

  40. Rittenhouse SR. The relevance of searching for effects under a clinical trial lamp post: a key issue. In review

  41. Grabowski H. Health reform and pharmaceutical innovation. Seton Hall Law Rev 1994; 24 (3): 1221–59

    Google Scholar 

  42. Moran DW, Wolfe PR. Can managed care control costs. Health Aff 1991; 10 (4): 120–8

    Article  CAS  Google Scholar 

  43. Berensen RA. A physician’s view of managed care. Health Aff 1991; 10 (4): 106–19

    Article  Google Scholar 

  44. Eisenberg JM. Williams Sv. Cost containment and changing physicians’ practice behavior. JAMA 1981: 246 (19): 2195–201

    Article  PubMed  CAS  Google Scholar 

  45. Hillman AL. Commentary: managing the physician: rules versus intentives. Health Aff 1991: 10 (4): 138–46

    Article  CAS  Google Scholar 

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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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