Effects of pharmaceutical cost containment policies on doctors' prescribing behavior: Focus on antibiotics

•We assessed pharmaceutical cost containment policies in South Korea.•We explored antibiotics for acute respiratory infections or otitis media.•The incentive program for physicians steadily reduced pharmaceutical spending.•There was no distinct effect of the incentive program on prescribing behaviors.•The price mark-down policy has immediately reduced pharmaceutical spending with no sustaining effects.

ObjectivesWe analyzed the effect of the outpatient prescription incentive program and price cuts of listed medicines in South Korea on prescription drug expenditures and prescription behaviors, focusing on antibiotics for the most common infectious diseases.MethodsWe used the National Health Insurance claims data from January 1, 2009 through December 31, 2012. For 1625 primary clinics randomly sampled, we included all claims with principal diagnoses of acute upper respiratory tract infections (URTIs, J00-J06), acute lower respiratory tract infections (LRTIs, J20-J22), or otitis media (H65, H66). An interrupted time-series analysis was conducted.ResultsPharmaceutical spending per claim dropped immediately after the outpatient prescription incentive program only for otitis media (adults), but the secular trend shifted downward after the incentive program for all target diseases. The incentive program lowered the trend of antibiotic prescribing rate in otitis media (adults). The program was associated with an increase of the number of antibiotics prescribed in URTI (adults) and LRTI (children) and decrease in otitis media (adults). The broad markdown of drug prices reduced pharmaceutical expenditures immediately for all diseases, but without lasting effect.ConclusionThe direct financial incentives to physicians to reduce in prescription spending had the intended effect over time and can be an important tool to improve pharmaceutical spending management.