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Joseph E Ibrahim

Publications and source records attributed to Joseph E Ibrahim.

7 recordsLinked to original sources
PubMed2005

Public disclosure of surgeon-specific report cards: current status of the debate.

Clinical report cards are at the centre of an escalating debate on ways in which the performance of hospitals and individual doctors can be monitored. Report cards are a method of publishing outcome data that can be focused on a particular hospital, clinical unit, or an individual doctor. Following the public disclosure of results of individual cardiac surgeons in New York State, USA, and the recent Inquiry into paediatric cardiac surgical deaths at the Bristol Royal Infirmary, UK, there is increasing focus on the possibility of the introduction of report cards in Australia. At present, the increasing momentum and implementation of report cards is focused squarely on surgeons, and particularly on cardiac surgeons. This review outlines the events in the USA and UK and looks into the possible impact of the introduction of report cards in Australia.

Australia↗
PubMed2002

Reference-based pricing schemes: effect on pharmaceutical expenditure, resource utilisation and health outcomes.

Pharmaceutical expenditure is rising more rapidly than the general inflation rate in most advanced countries. One strategy that has been introduced to control pharmaceutical costs is reference-based pricing (RBP). Its potential is restricted to those specific segments of the drug market where several drugs (and/or their generic forms) exist without substantial evidence that any particular agent is superior. Three broad approaches have been adopted. These involve the aggregation of drugs into generic groups, related drug groups (e.g. ACE inhibitors) or drugs grouped by therapeutic indication (e.g. antihypertensives). For each drug group, a single reimbursement level or reference price is set. Drugs above the reference price require part or total payment by the patient. The experience with RBP ranges from over 10 years in Germany (involving all levels of RBP) to the more recent implementation of RBP for related drug groups in Australia. This review summarises the current state of knowledge on RBP from the published experiences in the countries where RBP has been adopted. The published systematic reviews of RBP from the countries that have implemented it suggest that RBP has been successful at temporarily capping drug prices for the RBP drug groups and achieving short term cost savings. However, other factors influencing total pharmaceutical expenditure have often occurred simultaneously and make it difficult to isolate specific effects of RBP. Further investigation is required before any valid conclusions can be drawn about the net effect of RBP on healthcare costs. RBP has withstood the initial legal challenges of pharmaceutical companies and the criticisms of some clinicians. Where the reference price is based on the lowest priced drug(s) in the group, RBP appears to be one of the few strategies likely to be effective at encouraging doctors to use the least expensive agents as first-line therapy and utilise more expensive agents in those who experience side effects or poor efficacy.

Cost Control↗