(2002; 6 pages) [French] [Spanish]
10. Avoidance of perverse financial incentives
Financial incentives may strongly promote rational or irrational use. Examples include:
• Prescribers who earn money from the sale of medicines (e.g. dispensing doctors), prescribe more medicines, and more expensive medicines, than prescribers who do not; therefore the health system should be organized so that prescribers do not dispense or sell medicines.
• Flat prescription fees, covering all medicines in whatever quantities within one prescription, lead to over-prescription; therefore user charges should be made per medicine, not per prescription.
• Dispensing fees, calculated as a percentage of the cost of the medicines, encourage the sale of more expensive medicines; therefore a flat dispensing fee irrespective of the price of the medicine is preferable. Although it may lead to price increases for cheaper medicines, it lowers the price of higher cost medicines.
• Patients prefer medicines that are free or reimbursed. If only essential medicines are provided free by government or reimbursed through insurance, patients will pressure prescribers to prescribe only essential medicines. If medicines are only reimbursed when the prescription conforms to clinical guidelines, there may be an even stronger pressure on prescribers to prescribe rationally.