Rittenhouse B E
Division of Pharmacy Administration, School of Pharmacy, University of North Carolina at Chapel Hill, USA.
Pharmacoeconomics. 1994 Sep;6(3):222-32. doi: 10.2165/00019053-199406030-00006.
Efficient prescribing is a controversial concept when defined in economic terms. Such terms imply that neither the best nor the cheapest drug may be efficient. Efficiency depends on patient evaluations of outcomes--an essential, yet still underdeveloped, field of inquiry. Encouraging prescribing efficiency (once it is clear what efficient treatments are) may require the use of incentives, (economic and otherwise). Although physicians do react to economic incentives, encouraging them to also act as good economists rather than only as good healthcare providers may be difficult since economic efficiency goals may conflict with pure medical goals. While it is conceptually reasonable to assume that economic incentives will accomplish behavioural change, other (noneconomic) incentive mechanisms may appear less controversial. Since it is the result, not the process, that is important, a mix of incentives to achieve efficient solutions is suggested. However, further investigation into both health and economic outcomes research and debate on proper efficiency goals should precede the discussion of optimal incentives.
从经济角度定义时，有效开药是一个有争议的概念。这些术语意味着，最好的药物和最便宜的药物都不一定是有效的。效率取决于患者对结果的评估——这是一个至关重要但仍未充分发展的研究领域。鼓励开药效率（一旦明确了哪些治疗是有效的）可能需要使用激励措施（经济激励及其他激励）。尽管医生确实会对经济激励做出反应，但要鼓励他们不仅成为优秀的医疗服务提供者，还成为优秀的经济学家可能会很困难，因为经济效率目标可能与纯粹的医学目标相冲突。虽然从概念上讲，假设经济激励会带来行为改变是合理的，但其他（非经济）激励机制可能争议较小。由于重要的是结果而非过程，建议采用多种激励措施以实现有效的解决方案。然而，在讨论最佳激励措施之前，应先对健康和经济结果研究进行进一步调查，并就适当的效率目标展开辩论。
