Incentivisation practices and their influence on physicians’ prescriptions

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

• Adverse commercial determinants of health in low- and middle-income countries

  Open Access•M M Islam, Cassandra de Lacy‐Vawdon et al.•Health Promotion International•2025

  Incluir item

• Doctors taking bribes from pharmaceutical companies is common and not substantially reduced by an educational intervention

  Open Access•Mishal Khan, Muhammad Naveed Noor et al.•BMJ Global Health•2024

  Incluir item

• Healthcare consumers’ perceptions of incentive-linked prescribing

  Open Access•Muhammad Naveed Noor, Haider Safdar Abbasi et al.•PLOS Global Public Health•2024

  Incluir item

• How conflicts of interest hinder effective regulation of healthcare

  Open Access•Mishal Khan, Afifah Rahman-Shepherd et al.•BMJ Global Health•2022

  Incluir item

• Using ‘smart regulation’ to tackle antimicrobial resistance in low-income and middle-income countries

  Open Access•Gerard Porter, Jyoti Joshi et al.•BMJ Global Health•2020

  Incluir item

• Innovation in regulation of rapidly changing health markets

  Open Access•Gerald Bloom, Spencer Henson et al.•Globalization and Health•2014

  Incluir item

• What explains regulatory failure? Analysing the architecture of health care regulation in two Indian states

  Open Access•Kay Sheikh, Kabir Sheikh et al.•Health Policy and Planning•2015

  Incluir item

• Drug shop regulation and malaria treatment in Tanzania why do shops break the rules, and does it matter

  Open Access•Carl Goodman, Sp Kachur et al.•Health Policy and Planning•2007

  Incluir item

• What are the barriers to implementing national antimicrobial resistance action plans? A novel mixed-methods policy analysis in Pakistan

  Open Access•Mishal Khan, Mishal S Khan et al.•Health Policy and Planning•2020

  Incluir item