French GPs "Losing Freedom To Prescribe"

General practitioners in France are subject to increasing pressures, from a cost-cutting government, patients, medical reference guidelines and drug companies, and thus are losing their freedom to prescribe, concludes a detailed study conducted by TEV Consultants in collaboration with Droit et Pharmacie.

The study says economic restraint on prescribing runs counter both to the principle of free access to health care (so dear to the French) and freedom to prescribe (so dear to French doctors). However, it is seen as necessary because of the "chronic imbalance" of health care financing. Politicians do not really want to question the fundamentals of free access to health care while patients exist "in a universe of almost total irresponsibility," so the problems are diverted to the health care professionals who face "an arsenal of constraints."

The report says medical reference guidelines (RMOs), introduced in 1993, have been well observed by doctors after a cool reception. It puts their effect on 1994 sales of antibiotics (taken as a test category) as an average 16% drop, with sales of cephalosporins and broad-spectrum penicillins down 22%-25% and other antibiotics down 0%-8%. In contrast, sales of narrow- and medium-spectrum penicillins have risen 6%. The study concludes that it has been possible to change prescribing habits in a way that enables doctors to cut across patient demands which do not correspond to genuine therapeutic need.