2. Description of financial incentive policies of the included studies.

Country	Policy/Time period	Motivation	Setting of budget	Physician incentives	Physician disincentives	Theoretical effects
Taiwan	Drug reimbursement rate reduction, starting in 2000	Reducing prescription costs		Physicians earn a share of the revenue that hospitals gain from selling medicines	Reducing reimbursement rate reduces physicians' tendency to overprescribe	Fincianal incentives from drug sales affect physician prescribing. Removing this incentive will help to rationalise physician prescribing
Taiwan	National Health Insurance Drug Budget Programme, starting in 2002	Reducing prescription costs	Global budget based on an individual expenditure cap		Maximum expenditure cap
UK	Pay for performance (quality and outcome framework), starting in 2004	improving quality of care	NHS committed 1.8 GBP for funding the programme	Up to 25% increase in physician income (maximum of 31,000 GBP)		Direct financial incentives may result in improved quality of care, including prescribing
Sweden	Fixed pharmaceutical budget, 2000 to 2003	Controlling prescription drug costs	Previous year budget and demographic characteristics of patients	Remaining pharmaceutical budget was given to the health centre and can be used as bonus payment	Health centre had to repay any extra pharmaceutical expenditures	Making the health centres 'residual claimants' (i.e. responsible for deficits or surpluses) will directly affect the physicians prescribing. This may happen via reducing the number of prescriptions, reducing DDD per prescription or selecting cheaper alternative pharmaceuticals
Netherlands	Behaviour‐independent financial incentive, 2000 to 2002	Controlling prescription drug costs		On‐off bonus payment by the insurance company (paid before‐hand, irrespective of physician performance)	The decision to follow the regional formulary was made democratically in the presence of physician representatives and opinion leaders	Ownership of the decision via participation in development of the formulary and the decision to adopt the formulary via the insurance organisation is likely to improve physician performance towards the target behaviour
Germany	Collective drug budget "spending caps" (Health Care Reform Act), 1993 to 2002 (formally abolished in 2001)	Controlling prescription drug costs	Based on previous regional spending. From 1998: regional net budget = gross budget minus co‐payments and rebates from industry nationally set in 1993, then regionally Negotiated between physician associations and statutory health insurances	None (savings will not be available to physicians)	Regional physician associations are responsible for overspending (maximum 5% of total budget). Can decline to pay for excess spending and can request it from individual practice	Reduction in drugs with disputed effect, savings can facilitate use of more expensive drugs, improve quality of prescribing or increase referrals to save (drug budget is independent of other care)
Ireland	IDTSS (Indicative Drug Target Savings Scheme), starting in 1993	Controlling prescription drug costs	Individual practice budget based on previous spending and national average Negotiated by local medical advisor and practice	Savings were divided between GP and health authority	None	Decrease in prescribed drug volume and cost per item; improvement in quality of prescribing
UK	Fund‐holding in Great Britain and Scotland: April/1991 to 1997 (announced in 1990) in Wales and Northern Ireland 1993 to 1997	Controlling prescription drug costs	Based on previous spending of practice adjusted for patient mix and spending of comparators Negotiated by local health authority and practice	Savings can be invested by each fund‐holder to improve services in other budgets, or in the year following the year's drug budget	Responsible for overspending up to a limit of 5000£. Overspending can be covered by other budgets	Decrease in prescribed drug volume and cost per item; improvement in quality of prescribing. Referrals are postponed, as these are also part of a budget