Details
| Original language | English |
|---|---|
| Pages (from-to) | 696-713 |
| Number of pages | 18 |
| Journal | Health Economics (United Kingdom) |
| Volume | 33 |
| Issue number | 4 |
| Publication status | Published - 2 Mar 2024 |
Abstract
Many healthcare systems prohibit primary care physicians from dispensing the drugs they prescribe due to concerns that this encourages excessive, ineffective or unnecessarily costly prescribing. Using data from the English National Health Service for 2011–2018, we estimate the impact of physician dispensing rights on prescribing behavior at the extensive margin (comparing practices that dispense and those that do not) and the intensive margin (comparing practices with different proportions of patients to whom they dispense). We control for practices selecting into dispensing based on observable (OLS, entropy balancing) and unobservable practice characteristics (2SLS). We find that physician dispensing increases drug costs per patient by 3.1%, due to more, and more expensive, drugs being prescribed. Reimbursement is partly based on a fixed fee per package dispensed and we find that dispensing practices prescribe smaller packages. As the proportion of the practice population for whom they can dispense increases, dispensing practices behave more like non-dispensing practices.
Keywords
- drug expenditure, financial incentives, physician agency, physician dispensing, primary care
ASJC Scopus subject areas
- Medicine(all)
- Health Policy
Sustainable Development Goals
Cite this
- Standard
- Harvard
- Apa
- Vancouver
- BibTeX
- RIS
In: Health Economics (United Kingdom), Vol. 33, No. 4, 02.03.2024, p. 696-713.
Research output: Contribution to journal › Article › Research › peer review
}
TY - JOUR
T1 - Financial incentives and prescribing behavior in primary care
AU - Bodnar, Olivia
AU - Gravelle, Hugh
AU - Gutacker, Nils
AU - Herr, Annika
N1 - Funding Information: We are grateful to participants at the German Health Econometrics Workshop (2020), the German Health Economics Association Meeting (Augsburg 2019), the Eu- HEA PhD Student-Supervisor conference (Porto 2019), and the CINCH Academy (Essen, 2019) as well as seminars at Düsseldorf, Hannover, York, Monash, City, Manchester, Essen, Loughborough, Turin and Erlangen-Nürnberg for valuable comments and suggestions. OB received funding from the DFG Research Training Group Competition Economics (project 235577387/GRK1974)
PY - 2024/3/2
Y1 - 2024/3/2
N2 - Many healthcare systems prohibit primary care physicians from dispensing the drugs they prescribe due to concerns that this encourages excessive, ineffective or unnecessarily costly prescribing. Using data from the English National Health Service for 2011–2018, we estimate the impact of physician dispensing rights on prescribing behavior at the extensive margin (comparing practices that dispense and those that do not) and the intensive margin (comparing practices with different proportions of patients to whom they dispense). We control for practices selecting into dispensing based on observable (OLS, entropy balancing) and unobservable practice characteristics (2SLS). We find that physician dispensing increases drug costs per patient by 3.1%, due to more, and more expensive, drugs being prescribed. Reimbursement is partly based on a fixed fee per package dispensed and we find that dispensing practices prescribe smaller packages. As the proportion of the practice population for whom they can dispense increases, dispensing practices behave more like non-dispensing practices.
AB - Many healthcare systems prohibit primary care physicians from dispensing the drugs they prescribe due to concerns that this encourages excessive, ineffective or unnecessarily costly prescribing. Using data from the English National Health Service for 2011–2018, we estimate the impact of physician dispensing rights on prescribing behavior at the extensive margin (comparing practices that dispense and those that do not) and the intensive margin (comparing practices with different proportions of patients to whom they dispense). We control for practices selecting into dispensing based on observable (OLS, entropy balancing) and unobservable practice characteristics (2SLS). We find that physician dispensing increases drug costs per patient by 3.1%, due to more, and more expensive, drugs being prescribed. Reimbursement is partly based on a fixed fee per package dispensed and we find that dispensing practices prescribe smaller packages. As the proportion of the practice population for whom they can dispense increases, dispensing practices behave more like non-dispensing practices.
KW - drug expenditure
KW - financial incentives
KW - physician agency
KW - physician dispensing
KW - primary care
UR - http://www.scopus.com/inward/record.url?scp=85180851234&partnerID=8YFLogxK
U2 - 10.1002/hec.4793
DO - 10.1002/hec.4793
M3 - Article
AN - SCOPUS:85180851234
VL - 33
SP - 696
EP - 713
JO - Health Economics (United Kingdom)
JF - Health Economics (United Kingdom)
SN - 1057-9230
IS - 4
ER -