Pharmaceutical policies: effects of financial incentives for prescribers

Sturm, Heidrun; Austvoll‐Dahlgren, Astrid; Aaserud, Morten; Oxman, Andrew D; Ramsay, Craig; Vernby, Åsa; Kösters, Jan Peter

doi:10.1002/14651858.cd006731

Cited by 54 publications

(69 citation statements)

References 82 publications

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“…Using three recent reviews on pricing and purchasing policies, financial incentives for prescribers and co-payment and co-payment caps, the challenges and lessons for such reviews and future research are outlined. [3][4][5] The approach…”

Section: Box 31 Case Study: Heterogeneity Of Methods and Findings Inmentioning

confidence: 99%

The Role of Economic Perspectives and Evidence in Systematic Review

Anderson

Shemilt

2010

Evidence‐Based Decisions and Economics

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Section: Box 31 Case Study: Heterogeneity Of Methods and Findings Inmentioning

confidence: 99%

The Role of Economic Perspectives and Evidence in Systematic Review

Anderson

Shemilt

2010

Evidence‐Based Decisions and Economics

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“…31,32,33,34 Other reviews of the literature and issues -some of which were published after the overview of reviews 35,1,36,37,3,38,39 -are also relevant. The four reviews included were rated "moderate" in quality and included 32 different evaluations of financial incentives.…”

Section: Summary Of Conclusion Of Other Systematic Reviewsmentioning

confidence: 99%

Paying hospitals for quality: can we buy better care?

Hall

Gool

2016

Medical Journal of Australia

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6 Review the models as a group and summarise their strength of evidence ________________ 8 Summary of conclusions of other systematic reviews __________________________________ 8Responses to specific questions on funding models ___________________________________ 8 Some general principles and considerations for the design of incentive schemes ______ 10 Summary and discussion ____________________________________________________________ 14Implications for Australia ___________________________________________________________ 15 EXECUTIVE SUMMARYThe use of financial incentives to improve performance in health care is growing, and this trend is accompanied by an expanding literature. However, evidence for the impact of such schemes remains uncertain due to inadequate research designs and poorly designed incentive schemes. To date, few reviews have focused specifically on the use of such schemes aimed at clinicians working in hospitals.This review has been commissioned by the Sax Institute as part of their Evidence Check series of reports. Its aim is to describe and examine the evidence for the effects of incentive-based funding models for hospital clinicians on performance and quality of care.The review will:• Identify the range of incentive-based funding models for the provision of clinical services; • Review each individual model identified; and • Review the models as a group and examine the strength of evidence There is a large literature in this area which is reviewed.The review is based on:• An existing overview of systematic reviews;• More recent systematic reviews;• A primary literature search; and • Grey literature, including websites.A short conceptual framework is presented to help explain the mechanisms by which changes in funding models create incentives that in turn influence behaviour and performance.Numerous models exist in the United Kingdom, United States and Australia, but there is little rigorous empirical evidence of the effectiveness of changes in funding models for clinicians in hospitals. Those studies that do exist show mixed results, with the more robust studies showing no effect of pay-for-performance targeted at hospitals. One key reason suggested in the literature was that the additional funding was paid to hospitals. There were few reports as to whether and how this funding had been distributed to clinicians or clinical units within hospitals. The way the hospital uses the funds is crucial to the success of such schemes in improving performance and quality of care.What remains to be implemented and evaluated is a scheme that uses pay-for-performance to reward hospitals, combined with a mechanism that distributes the performance funding directly to clinical units and clinicians.Pay-for-performance schemes for hospitals include the Premier Hospital Quality Incentive Demonstration (US), the Commissioning for Quality and Innovation payment framework (UK), the Advancing Quality initiative (UK), best practice tariffs in Payment by Results (UK), and the Clinical Practice Improvement Payment Sys...

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“…Financial incentives have previously been shown to influence on the uptake of new drugs (149,150). A recent review showed that the mere presence of financial incentives may influence prescriptions (151). Based on 13 studies, this review concluded that when a group of physicians, or individual physicians, manage their own budget, they prescribe fewer and less expensive drugs.…”

Section: Outer Settingmentioning

confidence: 99%

Diffusion, implementation and consequences of new health technology : The cases of biological drugs for rheumatoid arthritis and the Swedish national guidelines

Kalkan¹

2015

Linköping University Medical Dissertations

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Improvements in health technology raise hopes for better patient outcomes and a more efficient delivery of health care. However, the processes of diffusion and implementation of new health technology have been shown to be complicated and to pose a number of challenges for the healthcare sector. Many at tempts have been made to influence and manage the introduction and diffusion of health technology. One prominent example is the Swedish nat ional guidelines that aim at influencing both clinical and political decision - making in the health sector. The overall aim of this thesis is to describe and analyze the factors influencing the diffusion and economic consequences of the introduction of a new technology with large variations in use, and to explore the process of implementation of nationally produced guidelines as an instrument for improv ing effectiveness and equity. The empirical focus is kept on the biological drugs (bDMARDs) for rheumatoid arthritis (RA), since they implied a substantial treatment change when they were first int roduced and they are relatively costly; and on the national guidelines for cardiac care, since they were the first nat ional guidelines, hence allowing a long-term perspect ive in the exploration of their implementat ion. Paper I presents a register study that uses data from national and regional registries on healt hcare use and work disability of patients with RA and shows that there was a 32 percent increase in the total fixed cost of RA during 1990-2010, mainly after the introduct ion of bDMARDs. Paper II shows that choosing to initiate treatment with bDMARDs varied substantially among 26 rheumatologists presented with hypothetical patient cases, and that there were also disparities between rheumatologists practicing in the same clinic. Paper III presents data from the Swedish Rheumatology Quality Register covering 4010 patients with RA, and shows that when using multivariate logistic regression to adjust for patient characterist ics, disease activity and t he physician’s local context, physician preference was an import ant predict or for prescription of bDMARDs. Paper IV is a qualitative study about prescribing decisions, showing that a constellat ion of various factors and their interact ion influenced the prescribing decisions according to the 26 interviewed rheumatologists. The factors included the individual rheumatologist ’s experiences and perceptions of t he evidence, the structure of the department including responsibility for costs, peer pressure, political and administrative influences, and participat ion in clinical trials. The patient as an actor emerged as an important factor. Paper V is a longitudinal qualitat ive study exploring the responses among four Swedish county councils to the national guidelines for cardiac care through 155 interviews with politicians, administ rators and clinical managers. The results show that unilateral responses to the national guidelines within the county councils have been rare, but there have been at tempts to compromise and to at ...

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Pharmaceutical policies: effects of financial incentives for prescribers

Cited by 54 publications

References 82 publications

The Role of Economic Perspectives and Evidence in Systematic Review

The Role of Economic Perspectives and Evidence in Systematic Review

Paying hospitals for quality: can we buy better care?

Diffusion, implementation and consequences of new health technology : The cases of biological drugs for rheumatoid arthritis and the Swedish national guidelines

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