Gender differences in the medical industries’ payments to physicians: a systematic review

Purpose

This paper aims to explore gender differences in payments made to physicians by the pharmaceutical and medical device industries via the performance of a systematic review of articles based on the Open Payments Database (OPD).

Design/methodology/approach

Three databases (Scopus, Web of Science and PubMed) were searched for articles published from September 30, 2014 to May 10, 2019, using two search terms: “Sunshine Act” and “Open Payments.” The systematic review is reported according to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines.

Findings

The search identified 359 abstracts. Thirty-nine articles were selected for full review, and 17 of these met the inclusion criteria. Although the articles considered are based on the same database, they adopt diverse approaches and analyses are conducted in different ways. A substantial proportion of the studies show total payments from the two industries to be higher for male physicians than for female physicians. However, a few exceptions exist, higher female mean or median values occurring for payments involving research, ownership, honoraria, grants, royalties/licenses and travel/lodgings. Also, in the case of obstetric–gynecological specializations, a higher proportion of women than men are shown to cooperate with the industries.

Originality/value

There is gender inequality in terms of industries’ funding for doctors. While analyses of secondary OPD data show that a gender inequality exists, they do not provide an understanding of why this occurs. However, from the exceptions identified, it can be speculated that this phenomenon is connected with greater adherence to ethical standards on the part of female physicians and/or the likelihood that fewer opportunities for industrial cooperation are extended to them.

Health plan auditing: 100-percent-of-claims vs. random-sample audits

The objective of this study was to examine the relative efficacy of two different methodologies for auditing self-funded medical claim expenses: 100-percent-of-claims auditing versus random-sampling auditing. Multiple data sets of claim errors or 'exceptions' from two Fortune-100 corporations were analysed and compared to 100 simulated audits of 300- and 400-claim random samples. Random-sample simulations failed to identify a significant number and amount of the errors that ranged from $200,000 to $750,000. These results suggest that health plan expenses of corporations could be significantly reduced if they audited 100% of claims and embraced a zero-defect approach.

The 2002 PhRMA Code and Pharmaceutical Marketing: did anybody bother to ask the reps?

After marketing tactics resulted in $1.2 billion fines, the 2002 PhRMA Code attempted to standardize marketing and sales practices. Self-regulation had varied success by other industries and by pharmaceutical industries in other countries. Similarly, the Code addressed negative responses about pharmaceutical's practices but had no provisions for monitoring violations. Representative's (reps) perspectives were assessed using an 18-item instrument with 72 reps from 25 companies. Analyses indicated that reps from bigger companies, PhRMA and non-PhRMA, adhered better. The way reps adhered was split between adhering reluctantly and following faithfully. Two thirds felt it was more difficult to do their jobs, resulting from prior entertainment-based relationships with physicians.

Afghanistan, poppies, and the global pain crisis

The World Health Organization has reported that somewhere between 30-86 million people suffer from moderate to severe pain due to cancer, HIV/AIDS, burns, wounds and other illnesses annually and do not have access to proper opiate anesthetics to control the pain [1]. The vast majority of these people live in poor nations where medicinal opiates are either too expensive or not readily available. In this paper, it is argued that access to adequate healthcare is a human right and that adequate healthcare includes management of pain. The solution to this problem may be in Afghanistan, a country now overwhelmed with poverty and war. Afghanistan is the world's leading producer of heroin. The increase in heroin production in Afghanistan has caused the United States and the international community to begin to eradicate Afghanistan's poppy fields leading to increased poverty among poppy farmers. This paper proposed a paradigm that can be implemented in Afghanistan which would allow for Afghan farmers to continue growing their poppy crop for medicinal opiates like morphine for poor nations. The paradigm covers all parameters of medicinal opiates production including licensing, security, cultivation, harvest, and factory production of medicinal opiates. The paradigm proposed is less expensive than eradication, brings honest income to Afghan farmers and the new Afghan nation, and can eventually lead to Afghanistan acquiring a respectable role in the world community. In closing, a full ethical analysis of the paradigm is included to justify the arguments made in the paper.

Quality of life in people with insomnia

OBJECTIVE

To determine whether subjects with insomnia report greater reductions in quality of life (QoL) than subjects without insomnia when assessed with self-report instruments.

METHODS

Questionnaires were completed by individuals recruited through media advertisements and screened with a structured telephone interview. Data obtained from 261 individuals with insomnia (INS group) were compared with those of 101 individuals with no sleep complaint, or controls (CTL group).

RESULTS

Subjects in the INS group obtained lower mean sum scores on the Medical Outcomes Study Cognitive Scale than did subjects in the CTL group (25.34 +/- 0.34 vs 31.91 +/- 0.58, t = 9.53, p < 0.0001). The INS group also obtained lower mean scores on all subscales of the SF-36 Questionnaire compared with those in the CTL group (each, p < 0.0001 or lower), indicating impairments across multiple QoL domains. Psychiatric assessment revealed that subjects in the INS group obtained significantly higher mean item scores than subjects in the control group on the Zung Depression Scale (2.22 +/- 0.03 vs. 1.52 +/- 0.03, p < 0.0001) and the Zung Anxiety Scale (1.96 +/- 0.02 vs. 1.40 +/- 0.04, p < 0.0001). In addition, subjects in the INS group reported significantly greater impairments in specific QoL domains on the QoL inventory, and the Work and Daily Activities Inventory. No differences were observed between subjects in the INS group who were receiving treatment for insomnia versus those who were untreated.

CONCLUSIONS

The results of this study indicate that significant QoL impairments are associated with insomnia.

Forecasting the adoption of new medical technology using the Bass model

A mathematical model, the Bass model, was used to forecast the adoption of new medical technology based on durable equipment. When the model was applied to five successful medical technologies, actual unit sales were predicted for three. The technologies investigated are computed tomography (CT scan), magnetic resonance imaging (MRI), ultrasound, hemodialysis, and lithotripsy. Because unit sales data for dialysis and ultrasound could not be obtained or estimated from secondary sources for the years immediately after market entry, application of the Bass model produced questionable results for those technologies. However, results for CT scan, MRI, and lithotripsy suggest that this model can be used to predict the adoption of new medical technology based on durable equipment when annual unit sales data can be estimated for the period immediately after market entry.