Baines D L, Whynes D K, Tolley K H
Department of Economics, University of Nottingham, England.
Pharmacoeconomics. 1997 Apr;11(4):350-8. doi: 10.2165/00019053-199711040-00006.
In April 1991, the fundholding and indicative prescribing schemes introduced budgets for expenditure on prescribed drugs into UK general practice. Although both schemes were designed to be equally effective at containing prescribing-cost inflation, several studies suggest that expenditure growth has been lower in fundholding practices, compared with nonfundholding practices. This study attempts to ascertain how fundholding practices control their expenditure by examining data from a rural English health authority for the financial year 1993 to 1994. The fundholding practices sampled were found to control their expenditure through: (i) reduced overprescribing; (ii) using fewer drugs that have limited clinical value; (iii) substituting similar, but less expensive, drugs; (iv) more generic prescribing; and (v) appropriate use of expensive preparations. However, whether the cost differential between fundholding and nonfundholding practices is sustained in future years will depend upon: (i) the ability of fundholding practices to generate further savings; (ii) the characteristics of the practices that enter the fundholding scheme in subsequent waves; (iii) the way in which the scheme is organised; and (iv) the level at which budgets are set.
1991年4月，基金持有计划和指导性处方计划将处方药支出预算引入了英国的全科医疗。尽管这两个计划在控制处方成本通胀方面的设计效果相同，但多项研究表明，与非基金持有诊所相比，基金持有诊所的支出增长较低。本研究试图通过研究英国一个农村卫生管理局1993年至1994财政年度的数据，来确定基金持有诊所如何控制其支出。抽样的基金持有诊所通过以下方式控制支出：（i）减少过度开药；（ii）减少使用临床价值有限的药物；（iii）用类似但更便宜的药物替代；（iv）更多地开通用名药；（v）合理使用昂贵的制剂。然而，未来几年基金持有诊所和非基金持有诊所之间的成本差异是否会持续，将取决于：（i）基金持有诊所进一步节省开支的能力；（ii）后续批次进入基金持有计划的诊所的特点；（iii）该计划的组织方式；（iv）预算设定的水平。
