[Physicians' experience with increased use of individual reimbursement for pharmaceuticals].
BACKGROUND
Implementation of a more restrictive reimbursement policy in Norway (in June 2003) has led to an increased use of individual reimbursement (patient application ) rather than general reimbursement (based on a positive list) of important pharmaceuticals. This study investigates physicians' attitudes to and experience with increased use of individual reimbursement one year after implementation of the new directive.


METHODS
Questions concerning individual reimbursement were included in a questionnaire to the Research Institute of the Norwegian Medical Association's reference panel in November 2004.


RESULTS
993 (71 %) of 1399 physicians responded to the questionnaire and 605 (61 %) of these reported that they had referred patients to a specialist or applied for individual reimbursement within the last year. About half (48 %) reported that the scheme contributes to rational use of pharmaceuticals, but more than 70 % were dissatisfied with the scheme and 87 % reported the scheme to be complicated and resource demanding. Only 37 % reported that all individual reimbursement applications were granted approval. 57 % reported that the scheme prevented them from prescribing the pharmaceutical they considered best for a patient, and 52 % reported that patients rather choose to pay for a pharmaceutical so treatment could start immediately. Administrative time for individual reimbursement applications was estimated to an average of 2.6 hours per month per physician.


CONCLUSIONS
The results indicate that physicians are considerably dissatisfied with the practical implications of this scheme. Comprehensive analyses of the total health consequences, costs and distributional effects of the increased use of individual reimbursement for important pharmaceuticals are needed.
Levorsen
Andrée
A
Institutt for helseledelse og helseøkonomi Universitetet i Oslo Postboks 1089 Blindern 0317 Oslo og MSD (Norge) AS. andreelowbar.levorsen@merck.com
Kristiansen
Ivar Sønbø
IS
Aasland
Olaf Gjerløw
OG
D001291:Attitude of Health Personnel; D003657:Decision Making; D016527:Drug Costs; D011307:Drug Prescriptions / Q000191:economics; D004363:Drug Utilization / Q000191:economics; D006801:Humans; D009664:Norway; D010818:Practice Patterns, Physicians' / Q000191:economics; D012051:Reimbursement Mechanisms / Q000191:economics; D011795:Surveys and Questionnaires