Strategies to improve the cost effectiveness of general practitioner prescribing. An international perspective

Prescribing costs are rising in all developed countries. The positive reasons for this are improved screening for diseases, aging populations and better drugs. The negative reason is prescribers' failure to use drugs cost effectively, i.e. in a scientifically and economically rational manner. It is for the latter reason that health administrators and managers, faced with cutbacks of other essential health provisions such as elective surgery, have found it necessary to intervene to attempt modification of general practitioner prescribing. This article describes the range of interventions in 3 continents, from the extreme of an essential drugs list to financial incentives and/or penalties for the patient and/or physician, to independent academic, educational interventions. The impact of hospital-initiated prescribing on general practice is briefly considered, as is the need to educate patients not to expect a prescription except when absolutely necessary. Finally, the inadequacy of medical school training in pharmacology and therapeutics is described, together with the need for formal postgraduate education in these topics for all prescribers, both general practitioner and hospital specialist.