EFFECT OF FUNDHOLDING AND INDICATIVE PRESCRIBING SCHEMES ON GENERAL-PRACTITIONERS PRESCRIBING COSTS

被引:87
作者
BRADLOW, J
COULTER, A
机构
[1] Dept. Public Health/Primary Care, University of Oxford, Radcliffe Infirmary
关键词
D O I
10.1136/bmj.307.6913.1186
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective-To compare general practitioners' prescribing costs in fundholding and non-fundholding practices before and after implementation of the NHS reforms in April 1991. Design-Analysis of prescribing and cost information (PACT data; levels 2 and 3) over two six month periods in 1991 and 1992. Setting-Oxford region. Participants-Three dispensing fundholding practices; five non-dispensing fundholding practices; and seven non-dispensing, non-fundholding practices. Main outcome measures-Percentage change in net cost of ingredients, number of items prescribed, average cost per item, and proportion of generic drugs prescribed after NHS reforms. Results-Prescribing costs increased in all practices in the six months after the reforms. The net costs of ingredients increased among dispensing fundholders by 10.2%, among non-dispensing fundholders by 13.2%, and among non-fundholders by 18.7%. The number of items prescribed also increased in all three groups (by 5.2%, 7.5%, and 6.1% respectively). The increase in average cost per item was 4.8% for dispensing fundholders, 5.3% for non-dispensing fundholders, and 11.9% for non-fundholders. Dispensing fundholders increased the proportion of generic drugs prescribed from 26.9% to 34.5% and non-dispensing fundholders from 44.5% to 48.7%; non-fundholders showed no change (47%). Five of the eight fundholding practices made savings in their drugs budgets at the end of the first year of fundholding (range 2.9-10.7%; the three other practices overspent by up to 3.6%). All non-fundholding practices exceeded their indicative prescribing amounts (range 3.2-20.0%). Conclusions-Fundholding has helped to curb increases in prescribing costs, even among dispensing general practitioners, for whom the incentives are different. Indicative prescribing amounts for non-fundholding practices do not seem to have had the same effect.
引用
收藏
页码:1186 / 1189
页数:4
相关论文
共 12 条
[1]  
CHEW R, 1992, ABPI BRIEFING JUL, P1
[2]  
CHEW R, 1992, COMPENDIUM HLTH STAT
[3]   EFFECT OF NHS REFORMS ON GENERAL-PRACTITIONERS REFERRAL PATTERNS [J].
COULTER, A ;
BRADLOW, J .
BRITISH MEDICAL JOURNAL, 1993, 306 (6875) :433-437
[4]   FUNDHOLDING GENERAL PRACTICES [J].
COULTER, A .
BRITISH MEDICAL JOURNAL, 1992, 304 (6824) :397-398
[5]  
HARRIS C, 1991, FACTORS INFLUENCING
[6]  
JONES T, 1993, PRIMARY CARE MANAGEM, V3, P5
[7]   PRESCRIBING COSTS IN DISPENSING PRACTICES [J].
MORTONJONES, TJ ;
PRINGLE, MAL .
BRITISH MEDICAL JOURNAL, 1993, 306 (6887) :1244-1246
[8]  
WEINER J, 1990, GP BUDGET HOLDING UK
[9]  
1993, STATISTICAL B
[10]  
1991, INDICATIVE PRESCRIBI