Incentivisation practices and their influence on physicians' prescriptions: A qualitative analysis of practice and policy in Pakistan.
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 physici...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2023-01-01
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| Series: | PLOS Global Public Health |
| Online Access: | https://doi.org/10.1371/journal.pgph.0001890 |
| _version_ | 1797694686761058304 |
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| author | Mishal Khan Afifah Rahman-Shepherd Muhammad Naveed Noor Sabeen Sharif Meherunissa Hamid Wafa Aftab Afshan Khurshid Isani Robyna Irshad Khan Rumina Hasan Sadia Shakoor Sameen Siddiqi |
| author_facet | Mishal Khan Afifah Rahman-Shepherd Muhammad Naveed Noor Sabeen Sharif Meherunissa Hamid Wafa Aftab Afshan Khurshid Isani Robyna Irshad Khan Rumina Hasan Sadia Shakoor Sameen Siddiqi |
| author_sort | Mishal Khan |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-12T03:00:25Z |
| format | Article |
| id | doaj.art-bce18d309abd4480ac3bf2c8b7e21599 |
| institution | Directory Open Access Journal |
| issn | 2767-3375 |
| language | English |
| last_indexed | 2024-03-12T03:00:25Z |
| publishDate | 2023-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLOS Global Public Health |
| spelling | doaj.art-bce18d309abd4480ac3bf2c8b7e215992023-09-03T14:47:27ZengPublic Library of Science (PLoS)PLOS Global Public Health2767-33752023-01-0136e000189010.1371/journal.pgph.0001890Incentivisation practices and their influence on physicians' prescriptions: A qualitative analysis of practice and policy in Pakistan.Mishal KhanAfifah Rahman-ShepherdMuhammad Naveed NoorSabeen SharifMeherunissa HamidWafa AftabAfshan Khurshid IsaniRobyna Irshad KhanRumina HasanSadia ShakoorSameen SiddiqiFocus 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.https://doi.org/10.1371/journal.pgph.0001890 |
| spellingShingle | Mishal Khan Afifah Rahman-Shepherd Muhammad Naveed Noor Sabeen Sharif Meherunissa Hamid Wafa Aftab Afshan Khurshid Isani Robyna Irshad Khan Rumina Hasan Sadia Shakoor Sameen Siddiqi Incentivisation practices and their influence on physicians' prescriptions: A qualitative analysis of practice and policy in Pakistan. PLOS Global Public Health |
| title | Incentivisation practices and their influence on physicians' prescriptions: A qualitative analysis of practice and policy in Pakistan. |
| title_full | Incentivisation practices and their influence on physicians' prescriptions: A qualitative analysis of practice and policy in Pakistan. |
| title_fullStr | Incentivisation practices and their influence on physicians' prescriptions: A qualitative analysis of practice and policy in Pakistan. |
| title_full_unstemmed | Incentivisation practices and their influence on physicians' prescriptions: A qualitative analysis of practice and policy in Pakistan. |
| title_short | Incentivisation practices and their influence on physicians' prescriptions: A qualitative analysis of practice and policy in Pakistan. |
| title_sort | incentivisation practices and their influence on physicians prescriptions a qualitative analysis of practice and policy in pakistan |
| url | https://doi.org/10.1371/journal.pgph.0001890 |
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