Cost to the patient or cost to the healthcare system? Which one matters the most for GP prescribing decisions? A UK-Italy comparison

Background: Charges for health services help contain healthcare costs. Despite showing that medicine consumption decreases when charges are increased there is little research that illuminates how doctors 'manage' the charge system to help patients who cannot afford treatment. This paper describes how the charge system influences the prescribing decisions of Italian and UK physicians. Methods: The data are from the qualitative stage of a multi-stage study exploring cost related influences on GP and patient decision-making regarding medicine use. The analysis presented is based on transcripts of focus groups conducted with general practitioners. Results: To help patients who have difficulties affording their medication Italian GPs rely on a smaller number of cost reduction strategies compared to their UK counterparts. They use 'samples' left by pharmaceutical companies, or diagnose patients with pathologies that allow exemption. Occasionally they recommend some delay or change therapy to a cheaper but less effective alternative. Italian and UK GPs have firm views about preventing patients abusing the NHS and believe costs to the system are as important as costs to the individual patient. Prescribing budgets were not viewed in a positive light by Italian GPs. Conclusion: Due to the nature of the charge system in Italy GPs there are able to choose a reimbursable product for patients, so have less need than UK doctors to look for other means of reducing costs. Conversely, the UK GPs have developed a large number of cost reduction strategies, probably because of the charge system itself and the relatively high charges incurred by patients.