Effects of a monetary incentive on primary care prescribing in Ireland: Changes in prescribing patterns in one health board 1990-1995

Background - In an attempt to curb the rapidly rising costs of primary care prescribing in Ireland, the government introduced a financial incentive sc heme in 1993, to encourage general practitioners to restrain their prescrib ing. Purpose - To investigate the effects of a financial incentive scheme on GP prescribing in Ireland on prescribing costs and volume, and on some specifi c therapeutic areas. Methods - Prescribing for 3 years before (1990-1992) and 3 years (1993-1995 ) after the introduction of incentives, based on a defined cohort of 233 ge neral practitioners in the area of one health board. GPs were divided into tertiles based on their performance against their prescribing budgets into 'savers' (generally underspent and received incentive payments), modest ove rspenders and large overspenders. Results - Savers were always lower cost prescribers than the other groups. They contained their rate and costs of prescribing in contrast to the other groups, e.g. percentage rise in prescribing costs in the year after the in troduction of the scheme -7.9%, + 1.2% and +7.3% respectively, (P < 0.05) f or savers, modest overspenders and large overspenders respectively. This ef fect was short lived however and was gone by the third year of the study. Conclusions - The financial incentives had a marked effect on prescribing v olume and cost on some practices who could achieve targets and hence incent ive payments. The incentives had little effect on high spending practices. Such incentive schemes need careful evaluation if they are not to become pe rverse to the good health of patients. Copyright (C) 2000 John Wiley & Sons , Ltd.