A comparison of prescribing patterns and consequent costs at Alexandra Health Centre and in the private fee-for-service medical aid sector.

About 25% of private health expenditure in South Africa goes on medicines. This compares with about 6% in the public sector, and about 12% in the UK. A major factor contributing to these differences is the prescribing practices of physicians, and generic prescribing in particular. This is a preliminary study to assess the savings that might be possible by altering prescribing practices. A sample of 528 scripts from Alexandra Health Centre (AHC) was analysed to calculate the average number of items per script and the average cost per script. In order to make the costs comparable to expenditure on medicines in the private fee-for-service sector, the scripts from AHC were costed as if they had been dispensed by private pharmacies--including dispensing fees, packaging costs and general sales tax. Since AHC clinicians generally prescribe medicines in the prepacked quantities, nothing is added to the costs for 'broken bulk'. However, as is the practice at AHC, cheaper therapeutic equivalents were substituted wherever possible. The number of items per script in the fee-for-service sector was 17% higher than at AHC, and the cost per item at AHC was one-quarter that in the private sector. Various explanations are offered including the possible incomparability of the case mix in the two sectors and the relative quality of care. However, the difference is so large that it is concluded that generic substitution, prepackaging and the use of treatment protocols by the clinicians are the major contributing factors.