Economic incentives and disincentives for efficient prescribing.

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.