Avoid perverse incentives:

Retaining professional independence, putting the patient first

The Rules relating to the Code of Conduct for Pharmacists and Other Persons Registered in terms of the Pharmacy Act require that a pharmacy professional’s prime concern in the performance of his/her professional duties must be the wellbeing of the patient and other members of the public. This article looks at the requirement for all persons registered with the South African Pharmacy Council to avoid perverse incentive schemes/arrangements so as to retain professional independence in the execution of their duties.

Avoid perverse incentives: Retaining professional independence, putting the patient first

Rule 1.6 of the Rules relating to Good Pharmacy Practice requires that pharmacy professionals retain professional independence and loyalty to the well-being of the patient more than any other considerations. Accordingly, “a registered member of the profession should refrain from entering into, or being part of any transaction or agreement, which may reflect negatively on his or her professional independence or the professionalism, or ethics of the profession as a whole”.

In Pharmacy, perverse incentives (Rule 1.6.3) and their corrupting aftereffects may present themselves from two avenues: 

  1. other entities/persons incentivising the pharmacy professional to engage in practices that are unethical and unbeneficial to the interest of the patient (Scenario 1 below); 
  2. the pharmacy professional incentivising others to engage in practices that are unethical and unbeneficial to the interest of the patient( Scenario 2 below). 

For further clarity, let us look at the above through two scenarios, both of which are unethical and unprofessional because they corrupt one party to consider their self-interest before the interests of the patient and public health.

Scenario 1

A manufacturer, a distributor of medicines/medical devices or their representative approaches a pharmacy professional or owner to promise or offer an incentive for such entity’s products or services to be provided or offered to the patient unnecessarily or without any apparent need for such products by the patient. The incentive offered may come in the form of financial gain or payment in kind, be it a free lunch, holiday, or any other valuable consideration. Alternatively, another health establishment or practitioner, or other entity, may approach the pharmacy professional to offer some kind of inducement in return for the pharmacy profession recommending patients to utilise their services and/or products, even when such service or product constitutes overservicing.

Scenario 2

On the other hand, the pharmacy professional may also unethically approach a healthcare practitioner to seek that such practitioner refers patients to their pharmacy in exchange for a certain commission or other valuable consideration. Both these scenarios are considered unethical as they have at their core personal interest.

This article only provides a summary of Rule 1.6.3, we encourage pharmacy professionals to access the Rules relating to Good Pharmacy Practice so as to remind themselves of the Good Pharmacy Practice requirements concerning perverse incentives.

Council thus reminds all members of the profession of their responsibility to prevent perverse incentives with regard to services and goods offered in pharmacies. It remains a registered person’s responsibility to sustain the honour and dignity of the pharmacy profession at all times and to refrain from any activity which may bring the profession into disrepute. 

Should you be aware of pharmacy professionals who are accepting or offering perverse incentives, you may report such conduct to Council for further investigation and possible disciplinary action

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