Medicine claims in South Africa : an analysis of the prescription patterns of providers in the private health care sector

Abstract

Due to the fact that the function of dispensing is not the exclusive practice of a single profession, there is much conflict surrounding the issue: it forms the crux of the pharmacy profession but it also forms part of doctors’ scope of practice. Separation of the acts of prescribing and dispensing would prevent the interest of the doctor, who has the potential to profit from selling medicines, being placed above the interest of the patient. It would, however, also affect the essential services that many dispensing doctors provide to pensioners, unemployed patients, those not covered by a medical scheme and those in rural areas. The implications of doctor dispensing are not clear as conflicting evidence suggests that dispensing doctors prescribe more medicine items, injections and antibiotics while preferring certain brand names on the one hand but on the other, evidence shows that dispensing doctors dispensed less expensive medicines compared to other health care providers. The main objective of this study was to analyse the prescribing patterns of dispensing doctors and other medicine providers in a section of the private health care sector of South Africa for 2005 to 2008 by using a medicine claims database. A retrospective drug utilisation review was conducted by extracting data from a medicine claims database for a four–year period, from 1 January 2005 to 31 December 2008. The results revealed that dispensing doctors had a lower cost per prescription compared to other health care providers (R112.66 ± R4.45 vs. R258.48 ± R23.93) and also had a lower cost per medicine item (R39.62 ± R2.18 vs. R112.43 ± R7.56) for the entire study period from 2005 to 2008. Dispensing doctors provided more items per prescription compared to other health care providers (2.85 ± 0.05 items vs. 2.30 ± 0.06 items) but other health care providers claimed more prescriptions per patient per year (7.50 ± 1.15 prescriptions vs. 3.29 ± 0.07 prescriptions). A higher percentage of generic medicine items were provided to patients visiting dispensing doctors. Dispensing doctors treated a majority of patients aged above 19 to 44 years of age while other health care providers treated a majority of patients above 59 years of age. Both dispensing doctors and other health care providers treated a majority of female patients and issued a majority of medicine items to treat acute conditions. The results also revealed that dispensing doctors generally provided relatively inexpensive medicine items, including generic and innovator items, for female and male patients of all ages while other health care providers showed the opposite trend and issued relatively expensive medicine items to these patients. However, when analysing the top twelve pharmacological groups claimed, dispensing doctors had relatively higher costs compared to other health care providers for nine of the pharmacological groups (central nervous system, analgesic, cardio–vascular, ear, nose and throat, dermatological, urinary system, antimicrobial, endocrine system and cytostatic). The pharmacological groups contributing to the highest number of medicine items and highest medicine cost contribution were the antimicrobial group for dispensing doctors and cardio–vascular group for other health care providers.