english.prescrire.org > Positions > Basic principles > Just what are we paid for?

Theme: Basic principles

What are the tenets that underpin our approach? A scientific spirit, respect for the evidence, tempered by scepticism. Humility, empathy and unwavering devotion to the patient’s interests. Most crucial perhaps is independence.

Just what are we paid for?

Does payment reflect the value of healthcare services? It is high time that France reform its healthcare system to move toward modes of remuneration and ways of working that promote quality, instead of providing incentives for greater volume and all sorts of commercial activities.

What are healthcare professionals paid for? Does payment reflect the value of the services they provide?

For pharmacists who are licensed to operate a pharmacy in France, the situation is a travesty. These pharmacists are essentially paid a percentage, a percentage of their sales. For drugs whose price is unregulated, the percentage can vary from one pharmacy to another, from one product to another, based on criteria such as their negotiating leverage with pharmaceutical companies or wholesalers, the socio-economic status of the neighbourhood, the degree of local competition, and government decisions.

Even for drugs that are reimbursed by the French national health insurance system, and whose prices are set, there is no explicit payment for any healthcare service. Pharmacists are not paid for educating or informing patients, for example, in clinical situations involving self-medication. They are not paid in relation to the time spent improving the quality of care: for instance, making sure that there are no dangerous interactions between treatments. Or the time spent preventing, tracking and reporting drugs' adverse effects. There are no incentives to discourage the overmedication of patients.

The system encourages the pharmacist to be motivated to only sell and to distribute products, not to care for people.

For physicians in private practice, the situation is just as bad. In France, a physician who is in private practice is also paid according to volume of patients and interventions. Whether their work involves a simple renewal, or a complex long-term prescription, managing a crisis, easing psychological distress, helping a chronically ill patient towards autonomy, time spent in education, lending a sympathetic ear: all this is paid for at the standard rate of about 20 euros.

Under these circumstances, healthcare professionals who, day in and day out, are interested first and foremost in their patients' welfare deserve to be praised!

The question "what are we paid for?" is important for everyone, not just healthcare professionals. It is also an important question for government: France needs to move towards modes of remuneration and healthcare systems that promote quality, instead of encouraging volume and all sorts of commercial activities.

©Prescrire 2008

Source: "Payés à quoi faire ?" Rev Prescrire 2008; 28 (301): 801.