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      Regulating the relationship between physicians and pharmaceutical companies: a qualitative and descriptive analysis of the impact of Israeli legislation


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          The Israeli National Health Insurance Law was amended in 2010 to require the disclosure of payments above 2500 NIS from pharmaceutical companies (PCs) to medical personnel and organizations. We examined if the law had an impact on the relationship between physicians in the Israeli health system and the pharmaceutical industry.


          We conducted 42 in-depth semi-structured interviews with representatives of relevant stakeholders regarding the effects and extent of the law and the interviewees’ attitudes about regulating the relationship between physicians and PCs. In addition, we analyzed reports on payments from PCs to various components of the health system.


          The majority of interviewees agreed that transparency is important to the relationship between PCs and physicians and none of them opposed the disclosure of payments. Most interviewees reported to have witnessed a change in the regulatory climate of the relationship between PCs and physicians, prompted mostly by self-regulatory measures of the pharmaceutical industry. The most significant change in this relationship appeared to be the enactment of contractual relations between PCs and physicians. There was a pervasive feeling that self-regulation is more effective than state regulation. The impact of the law on the behavior of individual physicians was claimed to be limited at best. Suggested causes were lack of awareness of the law, particularly among physicians; ambiguous definition of “payments” and loopholes in the law that attract other forms of remuneration to physicians and lack of enforcement of the law. According to reports published by the Ministry of Health, Pharma Israel, and the Israeli Medical association, although there had been some disclosure of payments by both donors and beneficiaries, there were inconsistencies between the total payments disclosed by PCs and those disclosed by their beneficiaries.


          There is a broad agreement that transparency is important to the PCs-physicians relationship. In addition, it seems that there was a change in the regulatory climate of that relationship; however, the feeling among the stakeholders is that self-regulation is more effective than state regulation. Therefore, efforts should focus on enforcement of the law and deterrence of its violations, possibly by investigating discrepancies between disclosed payment by donors and beneficiaries. The law should be amended to close loopholes. Furthermore, there should be periodic follow up of relevant databases, and relevant stakeholders should be interviewed in order to seek feedback and identify problems in implementation.

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          Most cited references19

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          Health industry practices that create conflicts of interest: a policy proposal for academic medical centers.

          Conflicts of interest between physicians' commitment to patient care and the desire of pharmaceutical companies and their representatives to sell their products pose challenges to the principles of medical professionalism. These conflicts occur when physicians have motives or are in situations for which reasonable observers could conclude that the moral requirements of the physician's roles are or will be compromised. Although physician groups, the manufacturers, and the federal government have instituted self-regulation of marketing, research in the psychology and social science of gift receipt and giving indicates that current controls will not satisfactorily protect the interests of patients. More stringent regulation is necessary, including the elimination or modification of common practices related to small gifts, pharmaceutical samples, continuing medical education, funds for physician travel, speakers bureaus, ghostwriting, and consulting and research contracts. We propose a policy under which academic medical centers would take the lead in eliminating the conflicts of interest that still characterize the relationship between physicians and the health care industry.
            • Record: found
            • Abstract: not found
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            The Dirt on Coming Clean: Perverse Effects of Disclosing Conflicts of Interest

              • Record: found
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              The Physician Payments Sunshine Act--Two Years of the Open Payments Program.


                Author and article information

                +972-3-906-6684 , rachelni@jdc.org.il
                Isr J Health Policy Res
                Isr J Health Policy Res
                Israel Journal of Health Policy Research
                BioMed Central (London )
                26 September 2017
                26 September 2017
                : 6
                [1 ]ISNI 0000 0000 9824 6981, GRID grid.411434.7, Department of Health System Management, , Ariel University, ; University Hill, 40700 Ariel, Israel
                [2 ]ISNI 0000 0001 0845 7919, GRID grid.419640.e, Myers-JDC-Brookdale Institute, ; Jerusalem, Israel
                [3 ]ISNI 0000 0004 1937 0511, GRID grid.7489.2, Department of Sociology and Anthropology, , Ben Gurion University of the Negev, ; Be’er Sheva, Israel
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                Funded by: FundRef http://dx.doi.org/10.13039/501100003976, Israel National Institute for Health Policy Research;
                Award ID: 162/2001/R
                Award Recipient :
                Original Research Article
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                © The Author(s) 2017

                Economics of health & social care
                physician-pharmaceutical companies’ relationship,payments,stakeholders,transparency,legislation


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