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Can pay-for-performance to primary care providers stimulate appropriate use of antibiotics?

Anell, Anders LU ; Ellegård, Lina Maria LU and Dietrichson, Jens LU (2015) In Working Paper / Department of Economics, School of Economics and Management, Lund University
Abstract
Resistance to antibiotics is a major threat to the effectiveness of modern health care. This study examines if pay-for-performance (P4P) to care providers stimulates the appropriate use of antibiotics; in particular, if P4P can induce a substitution away from broad-spectrum antibiotics, which contribute more to the development of resistance, to less resistance-driving types. In the context of Swedish primary care, we study the introduction of P4P indicators encouraging substitution of narrow-spectrum antibiotics for broad-spectrum antibiotics in the treatment of children with respiratory tract infections (RTI). During 2006-2013, 8 out of 21 county councils introduced such P4P indicators in their reimbursement schemes for primary care... (More)
Resistance to antibiotics is a major threat to the effectiveness of modern health care. This study examines if pay-for-performance (P4P) to care providers stimulates the appropriate use of antibiotics; in particular, if P4P can induce a substitution away from broad-spectrum antibiotics, which contribute more to the development of resistance, to less resistance-driving types. In the context of Swedish primary care, we study the introduction of P4P indicators encouraging substitution of narrow-spectrum antibiotics for broad-spectrum antibiotics in the treatment of children with respiratory tract infections (RTI). During 2006-2013, 8 out of 21 county councils introduced such P4P indicators in their reimbursement schemes for primary care providers. We employ municipality-level register data covering all purchases of RTI related antibiotics and exploit the staggered introduction of pay-for-performance in a difference-in-differences analysis. Despite that the monetary incentives were small, we find that P4P significantly increased narrow-spectrum antibiotics' share of RTI antibiotics consumption. We further find larger effects in areas where there were many private providers, where the incentive was formulated as a penalty rather than a reward, and where all providers were close to a P4P target. (Less)
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author
organization
publishing date
type
Working Paper
publication status
published
subject
keywords
pay-for-performance, antibiotics resistance, primary care
in
Working Paper / Department of Economics, School of Economics and Management, Lund University
issue
36
pages
34 pages
publisher
Department of Economics, Lund Universtiy
language
English
LU publication?
yes
id
34847430-aeb0-4a68-8801-5cef94b3fa85 (old id 8499755)
alternative location
http://project.nek.lu.se/publications/workpap/papers/wp15_36.pdf
date added to LUP
2016-01-05 10:01:34
date last changed
2016-07-07 12:43:27
@misc{34847430-aeb0-4a68-8801-5cef94b3fa85,
  abstract     = {Resistance to antibiotics is a major threat to the effectiveness of modern health care. This study examines if pay-for-performance (P4P) to care providers stimulates the appropriate use of antibiotics; in particular, if P4P can induce a substitution away from broad-spectrum antibiotics, which contribute more to the development of resistance, to less resistance-driving types. In the context of Swedish primary care, we study the introduction of P4P indicators encouraging substitution of narrow-spectrum antibiotics for broad-spectrum antibiotics in the treatment of children with respiratory tract infections (RTI). During 2006-2013, 8 out of 21 county councils introduced such P4P indicators in their reimbursement schemes for primary care providers. We employ municipality-level register data covering all purchases of RTI related antibiotics and exploit the staggered introduction of pay-for-performance in a difference-in-differences analysis. Despite that the monetary incentives were small, we find that P4P significantly increased narrow-spectrum antibiotics' share of RTI antibiotics consumption. We further find larger effects in areas where there were many private providers, where the incentive was formulated as a penalty rather than a reward, and where all providers were close to a P4P target.},
  author       = {Anell, Anders and Ellegård, Lina Maria and Dietrichson, Jens},
  keyword      = {pay-for-performance,antibiotics resistance,primary care},
  language     = {eng},
  number       = {36},
  pages        = {34},
  publisher    = {ARRAY(0xb37d1b0)},
  series       = {Working Paper / Department of Economics, School of Economics and Management, Lund University},
  title        = {Can pay-for-performance to primary care providers stimulate appropriate use of antibiotics?},
  year         = {2015},
}