E-drug: Influence prescribing by paying bonus
-------------------------------------------
Dear E-druggers,
In the Netherlands there seem to be continuing attempts to influence prescribing by offering bonuses for improved practices. A couple of years ago I reported on a trial in which family physicians were paid by a health insurer to prescribe less, and in which some of the savings of their improved prescribing were paid out to them ("Prescribe better - Make more money"). I did not hear much anymore of that trial, neither in E-drug, nor in The Netherlands.
Now a Dutch health insurer is trying again to influence prescribing by
paying out bonuses for improved behaviour (see BMJ article below, copied as fair use). This sort of thing interests me a lot, and I wonder what E-druggers think of it, and whether they are aware of similar trials elsewhere.
Hilbrand Haak
Consultants for Health and Development
--------------------------------------
Sleedoorntuin 7
2317 MV Leiden
The Netherlands
tel: +31-71-523.2052
fax: +31-71-523.3592
e-mail: haakh@chd-consultants.nl
Visit CHD's website at www.chd-consultants.nl
-----------
BMJ 2006;332:254 (4 February 2006)
Dutch insurance company will pay doctors to prescribe cheap drugs
Tony Sheldon
A court in the Netherlands has rejected attempts by doctors and patients' groups to stop a health insurance company offering financial rewards to doctors for prescribing cheap generic versions of statins and proton pump inhibitors.
The court ruled that the scheme, from Menzis, one of the largest health
insurers, does not remove doctors' independence or obligation to make their own choice of which drugs to prescribe. Such choices are based on professional standards to which the doctors must adhere and "there is nothing to show that doctors would deviate from these simply because of the
bonus," it concluded.
The Dutch Medical Association retains "serious objections" to the scheme, "strongly advising" its members against the scheme, which, it argues, amounts to an "undesirable influence on GPs prescribing behaviour."
The Menzis initiative is seen as a test case because the medical
profession is concerned that powerful health insurers will seek to influence clinical judgments to reduce costs. Insurers have been accused of "sitting in the doctor's chair."
Menzis, based in Groningen, is the market leader in health insurance in
parts of the Netherlands. GPs need contracts with Menzis to work in these areas. As part of these contracts, GPs are being invited to join a "rational prescribing module" in which they are financially
rewarded for new patients who choose cheaper generic medicines for
lowering cholesterol and reducing gastric acidity, such as the statin simvastatin and the proton pump inhibitor omeprazole.
GPs will receive bonuses for hitting annual targets of up to 85% of new
patients choosing simvastatin and 95% of new patients choosing omeprazole. Menzis says average bonuses could amount to 2000 (£1370; $2420) a year, but they stress that this can only be spent on "improvements in GP care."