Baines D L, Tolley K H, Whynes D K
Department of Economics, University of Nottingham, U.K.
J Clin Pharm Ther. 1996 Oct;21(5):343-8. doi: 10.1111/j.1365-2710.1996.tb00029.x.
The existence of significant disparities between the prescribing costs of dispensing and non-dispensing general practices has long been suspected, and received confirmation in a study of Lincolnshire, based on data for 1990-91. This study subsequently attracted much criticism. In this paper, we extend the analysis by considering annual cost and other prescribing data for Lincolnshire for the years between and including 1990-91 and 1993-94, in the light of the prescribing criteria developed by the Audit Commission. Our results show that dispensing practices had higher prescribing costs per patient for all the years analysed. In 1993-94, dispensing practices prescribed more items per patient (fewer of them generically) and were less capable of remaining within their prescribing budgets. The essential difference in prescribing costs lies in the area defined by the Audit Commission as 'core prescribing'. Using the Audit Commission's criteria for 'rational' prescribing, dispensing practices could make a significantly higher level of savings than non-dispensing practices. The findings lend support to the hypothesis advanced in the earlier analysis, namely, that the higher costs of prescribing in dispensing practices are accounted for primarily by management practice and the structure of incentives.
长期以来，人们一直怀疑配药和非配药全科医疗的处方成本存在显著差异，1990 - 91年基于林肯郡的数据进行的一项研究证实了这一点。这项研究随后受到了很多批评。在本文中，我们根据审计委员会制定的处方标准，对1990 - 91年至1993 - 94年（包括这两年）林肯郡的年度成本及其他处方数据进行分析，从而扩展了之前的研究。我们的结果表明，在所分析的所有年份中，配药医疗的每位患者处方成本更高。在1993 - 94年，配药医疗的每位患者处方数量更多（其中通用名药物较少），并且更难以控制在其处方预算范围内。处方成本的本质差异在于审计委员会定义为“核心处方”的领域。根据审计委员会的“合理”处方标准，配药医疗比非配药医疗能够节省的费用要高得多。这些发现支持了早期分析中提出的假设，即配药医疗较高的处方成本主要是由管理实践和激励结构造成的。
