The healthcare field as a marketplace: general practitioners, pharmaceutical companies, and profit-led prescribing in Pakistan

Abstract

The healthcare field as a marketplace: general practitioners, pharmaceutical companies, and profit-led prescribing in Pakistan Incentivisation of general practitioners (GPs) by pharmaceutical companies is thought to affect prescribing practices, often not in patients' interest. Using a Bourdieusian lens, we examine the socially structured conditions that underpin exchanges between pharmaceutical companies and GPs in Pakistan. The analysis of qualitative interviews with 28 GPs and 13 pharmaceutical sales representatives (PSRs) shows that GPs, through prescribing medicines, met pharmaceutical sales targets in exchange for various incentives. We argue that these practices can be given meaning through the concept of 'field' -a social space in which GPs, PSRs, and pharmacists were hierarchically positioned, with their unique capacities, to enable healthcare provision. However, structural forces like the intense competition between pharmaceutical companies, the presence of unqualified healthcare providers in the healthcare market, and a lack of regulation by the state institutions produced a context that enabled pharmaceutical companies and GPs to use the healthcare field, also, as space to maximise profits. GPs believed the effort to maximise incomes and meet socially desired standards were two key factors that encouraged profit-led prescribing. We conclude that understanding the healthcare field is an important step toward developing governance practices that can address profit-led prescribing.

Healthcare Consumers’ Perceptions of Incentive-Linked Prescribing: A Scoping Review of Research

“…This finding is consistent with several empirical studies with physicians, pharmaceutical companies, and other relevant stakeholders who testify to the unethical exchanges between physicians and pharmaceutical companies in various parts of the world. (4, 8, 13, 35, 36) This means that even though physicians and pharmaceutical companies may attempt to establish financial ties discretely, HCCs have a reasonable awareness of this practice.…”

“…This practice is thought to distort physicians’ prescribing behaviour. (1–3) When incentivised, physicians may choose to prescribe drugs, which are either unnecessary or expensive (4). Consequently, incentive-linked prescribing (ILP) may negatively affect patients’ health or exacerbate their financial difficulty.…”

“…Consequently, incentive-linked prescribing (ILP) may negatively affect patients' health or exacerbate their financial difficulty. (4)(5)(6) In recent years, there has been a steady stream of published studies about ILP from different parts of the world (5)(6)(7)(8). However, most of this work is based on research with physicians, the pharmaceutical industry, and other relevant stakeholders (i.e., regulators or nongovernmental organisations) rather than documenting the perspectives of HCCs.…”

Socioecological factors linked with pharmaceutical incentive-driven prescribing in Pakistan

“…[3][4][5] Our previous research from Pakistan identifies a range of incentives that GPs take from pharmaceutical companies, including money (in the form of cash/ cheque), items for clinic/home renovation (ie, clinical equipment, air conditioning units and furniture) and sponsorships for leisure trips and for attending local/international academic events. 6 Pharmaceutical incentivisation often leads to conflicts of interest in medical practice, as personal gains from pharmaceutical companies in return for prescribing may compromise GPs' professional judgement and their responsibility to consider patients' health and wellbeing. 7 Hence, GPs who are under a burden of reciprocity with pharmaceutical companies may prescribe expensive and/or unnecessary medicines, even when less expensive alternatives are…”

“…There is evidence that pharmaceutical companies often provide GPs with various incentives for prescribing their pharmaceutical products 3–5. Our previous research from Pakistan identifies a range of incentives that GPs take from pharmaceutical companies, including money (in the form of cash/cheque), items for clinic/home renovation (ie, clinical equipment, air conditioning units and furniture) and sponsorships for leisure trips and for attending local/international academic events 6. Pharmaceutical incentivisation often leads to conflicts of interest in medical practice, as personal gains from pharmaceutical companies in return for prescribing may compromise GPs’ professional judgement and their responsibility to consider patients’ health and well-being 7.…”