HSE considering new incentive scheme for GPs

The Health Service Executive is considering a new scheme of incentives to GPs to encourage more cost-efficient prescribing of drugs.

The HSE has told the Department of Health that such a scheme had the potential to generate savings in its drugs bill of up to €15 million.

The HSE confirmed at the weekend that it was examining a new initiative in this area but said there were no details finalised on how it would work.

A previous financial incentive scheme for GPs was suspended by the then minister for health Mary Harney after 13 years in operation.

Under that scheme GPs were given an annual target for savings on drugs costs. Those who came in under their targets were allowed to claim back up to half the amount saved to invest in their medical practices. Many doctors achieved savings by replacing branded drugs with cheaper generic versions of the same medication.

When it was in operation, a significant number of GPs received six-figure sums for investment in their practices. One general practice received just over €1 million.

Huge payouts

In 2003 a consultancy report commissioned by the Department of Health warned that the arrangements then in place left the State’s general medical services scheme facing the potential exposure of having to pay out significantly more under the scheme than the amount allocated for the purpose under the Government’s annual budgetary estimates.

In 2007 a review carried out by the National Centre for Pharmacoeconomics at St James’s Hospital at the request of the Department of Health found the indicative drug targeting scheme, as it was known, in its then form “was no longer achieving its stated objective”.

The analysis found that in 2005, just 2.75 per cent of the 2,200 family doctors who looked after patients with medical cards came in under target on their prescribing budget. The savings for the year fell to €670,462, well below those achieved when the scheme first commenced.

The HSE said in a statement at the weekend that it was carrying out “preliminary work at present on prescribing incentive measures – taking on board the lessons learned from previous such schemes and international experience in this area”.

“The overall objective is to reduce the cost of medicines to the State, while at the same time ensuring that we have capacity to pay for effective new drugs as they clear the development and clinical trial process.”

Substantial savings

“Significant controls in relation to drug prices have already been introduced in the formal generic substitution and reference pricing, which are now yielding substantial annual savings to the state. The next logical step is to balance these controls with additional measures to encourage preferred prescribing and ensure that further and better value is achieved for both patients and the tax payer. “

The HSE told the Department of Health in its submission for funding increases to be allocated in the budget for next year that under a new quality prescribing incentive initiative, a core dependency would be that all savings were “re-invested to support advancement of the integrated clinical programmes”.

The HSE suggested in its confidential internal report to the Department of Health that potentially €10 million could be saved on the prescribing of drugs for respiratory medicine. It said this would be subject to detailed planning being carried out and would take a number of years to reach full implementation.

It also forecast that up to €3 million could be generated in savings on prescribing of proton pump inhibitors – used commonly to treat ulcers in the stomach – as well as €2 million on the cost of prescribing statins which are used to lower cholesterol. The HSE said again in these areas it would take detailed planning a a number of years to achieve the full level of anticipated savings.