title: Is the prescribing behavior of Chinese physicians driven by financial incentives?
abstract: The prescribing behavior to prescribe high-priced drugs has been hypothesized to be related to the increasing drug expenditures in China, but little empirical evidence exists. The purpose of this study was to examine whether Chinese physicians, driven by financial incentives, tend to prescribe high-priced drugs. The 2000-2008 drug data in the Yangtze River Basin Hospitals' Drug Use Analysis System were analyzed to examine the prescription patterns of penicillins and cephalosporins in Shanghai. Among the top-100 drugs (by volume), cephalosporins cost as 1.1- 2.3 times as penicillins and their volume was 1.7-18.2 times. Revenues generated from prescribing cephalosporins were 3.4-24.2 times as those from prescribing penicillins. The tendency of prescribing relatively high-priced drugs was observed given the same chemical name, dosage, and specification but different trade names. Furthermore, high-priced drugs remained on the top-100 list with increasing volumes, while some lower-priced drugs exited from the list due to decreases in volumes. Facing the policy dilemmas, the Chinese government needs to implement a new financially rewarding system in which hospitals and physicians are able to achieve financial gains in a cost-effective way including prescribing similar drugs with lower prices. Reforming hospitals' payment methods is necessary and feasible to reshape financial incentives of healthcare providers. The combination of the global budget policy and financial incentive measures would be likely to change providers' prescribing behaviors towards a cost-effective direction.
authors.affiliation: Research Institute of Health Development Strategies, Fudan University, 130 Dong An Road, Shanghai 200032, China.
authors.forename: Chun
authors.initials: C
authors.lastname: Chen
authors.affiliation: Department of Sociology and Legal Studies, University of Waterloo, 200 University Ave. W. Waterloo, Ontario, Canada N2L 3G1; Munk School of Global Affairs, University of Toronto, 315 Bloor Street West (At the Observatory) Toronto, Ontario, Canada M5S 0A7.
authors.forename: Weizhen
authors.initials: W
authors.lastname: Dong
authors.affiliation: Department of Health Care Administration and Policy, School of Community Health Sciences, University of Nevada, Las Vegas, 4505 S. Maryland Parkway, Box 453023, Las Vegas, NV 89154-3023, USA.
authors.forename: Jay J
authors.initials: JJ
authors.lastname: Shen
authors.affiliation: Department of Health Care Administration and Policy, School of Community Health Sciences, University of Nevada, Las Vegas, 4505 S. Maryland Parkway, Box 453023, Las Vegas, NV 89154-3023, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Cochran
authors.affiliation: Research Institute of Health Development Strategies, Fudan University, 130 Dong An Road, Shanghai 200032, China. Electronic address: wangying1013@fudan.edu.cn.
authors.forename: Ying
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Research Institute of Health Development Strategies, Fudan University, 130 Dong An Road, Shanghai 200032, China. Electronic address: haomo03@fudan.edu.cn.
authors.forename: Mo
authors.initials: M
authors.lastname: Hao
mesh_terms: D002681:China; D016527:Drug Costs; D017850:Economics, Pharmaceutical; D006291:Health Policy; D006786:Hospitals, Urban; D006801:Humans; D058007:Physicians, Primary Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D055553:Prescription Drugs / Q000191:economics*; D012052:Reimbursement, Incentive / Q000191:economics*
chemical_list: D055553:Prescription Drugs
keywords: China; Drug price; Health policy; Pharmacoeconomics; Prescribing behavior