The incentives cost UK taxpayers around £1 bn annually—and the average family doctor can earn, on average, an extra £17,000 ($21,711) a year to prescribe drugs for a range of chronic conditions, such as heart disease, high blood pressure, stroke, diabetes and kidney disease.
But the patient isn't benefiting. A major review of cash-for-prescriptions schemes has found that the drugs aren't helping the patient live a longer life or reducing the rate of hospital admissions for conditions such as heart disease and cancer.
And the researchers from the University of Medicine School of Public Health didn't take into account the adverse reactions and side effects the drugs routinely cause, which is an added burden on healthcare systems.
Cash-for-prescriptions schemes operate in many developed countries, but the researchers focused on the UK's programme, called Quality and Outcomes Framework (QOF), which was introduced in 2004. Comparing populations and diseases targeted by QOF in countries that had an incentive scheme and others that didn't, the researchers discovered that the drugs hadn't improved longevity levels. "Extensive research into pay-for-performance programmes has yet to show clear patient benefits," the researchers said.
QOF was designed to encourage doctors to prescribe 'proven' drugs to treat chronic diseases before they worsened and needed hospital care. But the proof has come from trials funded by the manufacturer—and independent research is showing they offer very little benefit, if any at all. As the researchers noted, "evidence from clinical trials might not translate into patient benefits in the real world."
(Source: The Lancet, 2018; 388: 268-74)