Incentivisation practices and their influence on physicians’ prescriptions

A qualitative analysis of practice and policy in Pakistan

Bibliographic Data

ID19591794
AuthorsMishal Khan (0000-0002-8967-1761, Aga Khan University, corresponding author), Afifah Rahman-Shepherd (0000-0002-8845-9275, London School of Hygiene & Tropical Medicine, corresponding author), Muhammad Naveed Noor (0000-0002-7847-6637, Aga Khan University, corresponding author), Sabeen Sharif (0000-0002-3848-6443, Aga Khan University, corresponding author), Meherunissa Hamid (0000-0002-8569-304X, London School of Hygiene & Tropical Medicine, corresponding author), Wafa Aftab (0000-0001-5040-5215, Aga Khan University, corresponding author), Afshan Khurshid Isani (Government of Pakistan, corresponding author), Robyna Irshad Khan (Aga Khan University, corresponding author), Rumina Hasan (0000-0003-3738-117X, Aga Khan University, corresponding author), Sadia Shakoor (0000-0003-1301-5239, Aga Khan University, corresponding author), Sameen Siddiqi (0000-0001-8289-0964, Aga Khan University, corresponding author)
EditorsJulia Robinson (0000-0003-0719-3995)
Year2023
Volume3
Issue6
Pagese0001890
Publication date2023-06-29
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenuePLOS Global Public Health (JOURNAL)
Journal identifiersISSN: 2767-3375 • E-ISSN: 2767-3375
PublisherPublic Library of Science (PLoS) (PUBLISHER)
DOI10.1371/journal.pgph.0001890
PMID37384598
OpenAlexW4382631457
LanguageEN
Citations received3
References cited20

Focus on profit-generating enterprise in healthcare can create conflicts of interest that adversely impact prescribing and pricing of medicines. Although a global challenge, addressing the impacts on quality of care is particularly difficult in countries where the pharmaceutical industry and physician lobby is strong relative to regulatory institutions. Our study characterises the range of incentives exchanged between the pharmaceutical industry and physicians, and investigates the differences between incentivisation practices and policies in Pakistan. In this mixed methods study, we first thematically analysed semi-structured interviews with 28 purposively selected for-profit primary-care physicians and 13 medical sales representatives from pharmaceutical companies working across Pakistan’s largest city, Karachi. We then conducted a content analysis of policies on ethical practice issued by two regulatory bodies responsible in Pakistan, and the World Health Organization. This enabled a systematic comparison of incentivisation practices with what is considered ‘prohibitive’ or ‘permissive’ in policy. Our findings demonstrate that incentivisation of physicians to meet pharmaceutical sales targets is the norm, and that both parties play in the symbiotic physician-pharma incentivisation dynamics. Further, we were able to categorise the types of incentive exchanged into one of five categories: financial, material, professional or educational, social or recreational, and familial. Our comparison of incentivisation practices with policies revealed three reasons for such widespread incentivisation linked to sales targets: first, some clear policies were being ignored by physicians; second, there are ambiguous or contradictory policies with respect to specific incentive types; and third, numerous incentive types are unaddressed by existing policies, such as pharmaceutical companies paying for private clinic renovations. There is a need for policies to be clarified and updated, and to build buy-in for policy enforcement from pharmaceutical companies and physicians, such that transgressions on target-driven prescribing are seen to be unethical

Business · Economic growth · Economics · Focus group · Health care · Incentive · Medical prescription · Pharmaceutical industry · Pharmaceutical policy · Political science · Public economics · Public relations · Qualitative research · Sociology · Healthcare cost, quality, practices · Medicine · Nursing · Pharmaceutical Economics and Policy · Pharmaceutical industry and healthcare · Health Policy · Marketing