How has fundholding in Northern Ireland affected prescribing patterns? A longitudinal study.

OBJECTIVE

To compare prescribing patterns in general practices before and after the introduction of fundholding in April 1993 to determine whether fundholding changed prescribing patterns among practices that joined the scheme.

DESIGN

Analysis of prescribing data from the Drug Utilisation Research Unit's database for all practices in Northern Ireland during April 1989 to March 1996.

SETTING

Northern Ireland.

SUBJECTS

23-first wave fundholders, 34 second wave fundholders, 9 third wave fundholders, and 268 non-fundholders.

MAIN OUTCOME MEASURES

Prescribing costs per 1000 patients, prescription items per 1000 patients, average cost per item, and rate of generic prescribing.

RESULTS

Prescribing costs and frequency increased in all groups throughout the study. Among the fundholders the rate of increase in costs after fundholding was significantly lower than among non-fundholders. The rate of increase in cost per item fell, coinciding with a significant increase in the rate of generic prescribing. However, with regard to first wave fundholders, their yearly increase in costs in their third year as fundholders (1995-6) was similar to that of the non-fundholders. The earlier practices that joined the scheme seemed to differ in some important respects from those that joined later.

CONCLUSIONS

After fundholders joined the fundholding scheme their patterns of prescribing changed compared with those of non-fundholders: the rate of increase in costs fell and there was a significant rise in the rate of generic prescribing.