Effects of a monetary incentive on primary care prescribing in Ireland: Attitudes and perceptions of healthcare professionals and patients

Abstract

Objective: In 1993, a scheme to provide incentives to general practitioners to contain the costs of their prescribing to publicly funded patients was introduced in Ireland. We set out to describe the attitudes to this scheme of each of the major stakeholder groups: patients, general practitioners and community pharmacists. Methods: Questionnaire survey of each stakeholder group: 200 general practitioners (by telephone), five patients from each general practitioner (total 1000), and also 250 community pharmacists: these last two groups were surveyed by post. Results: Response rates for GPs were 79%, pharmacists 52%, and patients 29%. General practitioners were broadly supportive of the scheme, with those GPs achieving savings being most supportive. Their patients were generally unaware of the scheme, but many seemed to have experienced the effects of the scheme, with 38% reporting having had less expensive brands of medication substituted for more expensive. No patients reported suffering any harm as a result. Patients were keen to know more about the scheme. Pharmacists were generally opposed to the scheme, and their level of opposition was related to the financial losses that they had suffered as a result of it. Conclusions: Doctors generally supported the scheme and pharmacists opposed it. Their support for the scheme was dependent on the benefits that is brought to them individually. Patients were unaware of the scheme but seemed to have suffered no harm as a result. Such incentive schemes need to include careful evaluation of their effects on each of the stakeholders.