How has fundholding in Northern Ireland affected prescribing patterns? A longitudinal study

• Published in: BMJ 1997-07, Vol.315 (7101), p.166-170
• Main Authors: Rafferty, Thérèse, Wilson-Davis, Keith, McGavock, Hugh
• Format: Article
• Language: English
• Subjects: Brand name drugs; Cost efficiency; Cost estimates; Cost incentives; Cost savings; Drug Costs; Drug prescriptions; Drug Prescriptions - economics; Drugs, Generic - economics; Family Practice - economics; Family Practice - trends; Financial budgets; Financial Management; General practice; Humans; Longitudinal Studies; Northern Ireland; Practice Patterns, Physicians' - economics; Practice Patterns, Physicians' - trends; Prescription drugs; Savings motives
• ISSN: 0959-8138; 1468-5833; 1756-1833

Abstract Objective: To compare prescribing patterns in general practices before and after the introduction of fundholding in April 1993 to determine whether fundholding changed prescribing patterns among practices that joined the scheme. Design: Analysis of prescribing data from the Drug Utilisation Research Unit's database for all practices in Northern Ireland during April 1989 to March 1996. Setting: Northern Ireland. Subjects: 23 first wave fundholders, 34 second wave fundholders, 9 third wave fundholders, and 268 non-fundholders. Main outcome measures: Prescribing costs per 1000 patients, prescription items per 1000 patients, average cost per item, and rate of generic prescribing. Results: Prescribing costs and frequency increased in all groups throughout the study. Among the fundholders the rate of increase in costs after fundholding was significantly lower than among non-fundholders. The rate of increase in cost per item fell, coinciding with a significant increase in the rate of generic prescribing. However, with regard to first wave fundholders, their yearly increase in costs in their third year as fundholders (1995-6) was similar to that of the non-fundholders. The earlier practices that joined the scheme seemed to differ in some important respects from those that joined later. Conclusions: After fundholders joined the fundholding scheme their patterns of prescribing changed compared with those of non-fundholders: the rate of increase in costs fell and there was a significant rise in the rate of generic prescribing. Key messages The effects of fundholding on prescribing costs have been disputed Fundholders in Northern Ireland contained the rate of increase in prescribing costs more effectively than non-fundholders Fundholders increased their rate of generic prescribing by an average of 13% in the first year of fundholding The incentive to make further savings may have diminished after two years of fundholding