Biomedical subjects
B Yule
Publications and source records attributed to B Yule.
Do physicians' perceptions of drug costs influence their prescribing?
This study examines general practitioner (GP) attitudes towards and knowledge of prescribing costs, and the influence of these 2 factors in the doctor's demand for drugs. The main emphasis of the study is on the influence of perceived cost of drugs on prescribing habits. A postal questionnaire was sent to all 273 GP principals in the Grampian region of Scotland. This questionnaire assessed GPs' attitudes and knowledge with respect to prescribing costs. Information was also collected on the prescribing habits of 176 of these GPs. This information was linked to look at the influence GPs' knowledge of drug costs has on their actual prescribing behaviour. Three drug groups were studied: ulcer-healing drugs, pain-killers and penicillins. The results showed that although most GPs agreed that costs should be borne in mind when prescribing medicines, their actual knowledge of the drug costs was often inaccurate. Furthermore, for certain therapeutic groups, prescribing habits are influenced by GPs' perceptions of drug costs. This implies that GPs are not as averse to considering costs as is often assumed, and that giving GPs better information about drug costs might promote more rational prescribing.
Fundholding: the next five years.
On 1 April 1993 third-wave fundholders (second-wave fundholders in Scotland) received their budgets. In some areas, over 50 per cent of the population are now served by fundholding practices. This paper examines the limited evidence to date on the effects of fundholding. Four areas of concern are identified: priority setting by fundholders; the management of financial risk; budget setting; and the allocation of resources between fundholders and non-fundholders. In each of these areas, ways in which the scheme might be improved are discussed.
A randomized trial of immediate discharge of surgical patients to general practice.
BACKGROUND: This study compares, in clinical and economic terms, out-patient follow-up with immediate discharge to general practice of patients undergoing any one of 29 defined surgical procedures. METHODS: A randomized controlled trial was undertaken in which patients recruited from two general surgery wards in Ninewells Hospital, Dundee, were randomized to follow-up care in the out-patient clinic or in general practice. Outcome was measured as clinical effectiveness in terms of morbidity and mortality; economic costs to the hospital compared with general practice; patient benefits and satisfaction; and General Practitioners' (GPs') opinions of the system. RESULTS: A total of 455 patients were randomized to outpatient and 454 to general practice follow-up. They were followed up for a minimum of six months. There were no differences in readmission rates, mean number of operations or mortality. The difference between the groups in the total health service costs was very small (2.68 pounds per patient more for those receiving out-patient follow-up). More of the general practice group preferred general practice care than the out-patient group preferred out-patient care (p = 0.03). The patient's travel costs and travel and treatment time were greater for the out-patient group (27.99 pounds, 113 min) than for the general practice group (24.90 pounds, 82 min). The GPs felt they had been given adequate information in the discharge documentation and were willing to accept immediate discharge as normal policy, although they expected it to increase their workload. If immediate discharge were instituted, the time saved in an out-patient clinic session of 40 patients would be an estimated 54 minutes, enough to see three extra new patients. CONCLUSION: General practice based follow-up care for this group of patients is as effective as, but less costly than outpatient care and is acceptable to GPs. Because of only small differences in costs between the two forms of follow-up, real gains to the health service will depend on the use of the time freed by a reduction in follow-up appointments in the out-patient clinic.
The way to economic prescribing.
Concern about the size of the NHS drugs bill in the UK has resulted in three main policy initiatives by government: regular increases in prescription charges, the introduction of restrictions on the range of prescribable drugs, and the implementation of prescribing budgets. This paper argues that such policies, whilst reducing the NHS drugs bill, have given little consideration to the efficiency of prescribing. Other policy options are considered which may reduce the NHS drugs bill in ways more consistent with efficient prescribing.
Dental care in the NHS: reforms with teeth?
Dental services in the UK are currently undergoing a period of major upheaval. This paper examines recent policy initiatives with respect to patient charges, dentists' remuneration, information and patient choice, the supply of dental personnel, and the prevention of dental diseases. It is argued that changes in dentists' remuneration and the greater use of auxiliary personnel are likely to improve efficiency, whereas changes in patient charges are not. Water fluoridation remains the most efficient and equitable means of promoting dental health.
The effect of per-item fees on the behaviour of general practitioners.
The recent government White Paper 'Working for Patients' emphasised the use of financial incentives as a means of altering the behaviour of general practitioners (GPs) in the U.K. This paper examines the impact of financial incentives on GPs' behaviour with respect to maternity care and cervical cytology. Changes in per-item fees over the period 1966-89 appear to have had little effect on the numbers of treatments; rather service provision was related to patient demand and the availability of GPs. However, target payments for cervical cytology introduced in 1990 appear to have had a major impact.
Knowledge of drug costs: a comparison of general practitioners in Scotland and England.
The implementation of drug budgets will make it essential that general practitioners are aware of prescribing costs. A previous study of general practitioners in Scotland found that their knowledge of drug costs was often inaccurate. At the time of the Scottish study, doctors received very limited information on prescribing costs. By contrast, general practitioners in England have been receiving much more detailed information on their prescribing costs since the introduction of PACT (prescribing analyses and cost) in 1988/89. This study examines whether, as a result, doctors in England are more aware of drug costs. The results suggest that they are not; indeed, doctors in Scotland had marginally better knowledge of drug costs. There is a continuing need to improve the cost information available to general practitioners.
Awareness of drug costs among general practitioner trainees.
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Scottish general practitioners' attitudes and knowledge in respect of prescribing costs.
The government's proposal to introduce drug budgets will compel general practitioners to consider the financial consequences of prescribing. A survey was carried out of general practitioner principals in Grampian and a sample elsewhere in Scotland to examine their attitudes towards considering costs when prescribing and assess the accuracy of their knowledge of drug costs. Most general practitioners agreed that costs should be borne in mind when choosing medicines but their knowledge of drug costs was often inaccurate. Only one third of estimates were correct to within 25% of the actual cost, and there was a tendency to overstate the cost of cheap drugs and understate the cost of expensive ones. Some general practitioners were not aware of the relative prices of competing products or proprietary products and generic equivalents. The findings highlight the importance of providing general practitioners with readily accessible and up to date information on drug costs if prescribing budgets are to work.
Switching drugs from prescription-only to over-the-counter availability: economic benefits in the United Kingdom.
Recent years have seen suggestions that legislation restricting certain drugs to prescription-only availability should be relaxed. This paper estimates the economic benefits of such changes, with specific reference to two drugs recently switched in the United Kingdom: Ioperamide and 1% topical hydrocortisone. The findings suggest that making these products available from the pharmacy without a prescription has resulted in substantial benefits by reducing costs to consumers and saving general practitioners' time. In view of these benefits, the disadvantages of such changes should be evaluated.
Aggregate health care expenditures and national income. Is health care a luxury good?
It is well known that a strong relationship exists between national expenditures on health care and national income. This has been used to suggest that health care is a luxury good, and that factors such as the type of health care delivery system in a country are of little importance in determining expenditure levels. This paper argues that these implications rely upon the application of microeconomic analysis to macroeconomic data, and that this is not appropriate. As well as raising questions about the inferences drawn from previous studies, new empirical evidence is presented which casts some doubts on previous findings. International comparisons are based on Purchasing Power Parity rather than exchange rate conversions, underlining the importance of prices as well as quantities in the relationship, and leading to the conclusion that the aggregate data show health care to be, if anything, a necessity rather than a luxury good.
The demand for dental care: an assessment.
This paper reviews the existing literature on the demand for dental care and assesses its implications for the U.K., where such analysis has been lacking to date. The characteristics of the U.K. dental system are briefly outlined, and some observations on the theory of the demand for dental care are made. The main part of the paper consists of a review of empirical work, most of which is North American or Scandinavian. It is concluded that there is as yet no consensus on several empirical matters of major importance. Areas for future research, both in the U.K. and more widely, are presented.
Perspectives on health economics. 3. Economics in action.
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Transport: the case for community cars.
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Non-accidental injury to children--III. Methodological problems of evaluative treatment research.
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Perspectives on health economics. 1. An introduction to economics in health care.
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