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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)
Please use this url to cite or link to this publication:
author
; and
organization
publishing date
type
Working paper/Preprint
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 University
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
2016-04-04 11:19:41
date last changed
2018-11-21 21:04:07
@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}},
  keywords     = {{pay-for-performance; antibiotics resistance; primary care}},
  language     = {{eng}},
  note         = {{Working Paper}},
  number       = {{36}},
  publisher    = {{Department of Economics, Lund University}},
  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?}},
  url          = {{http://project.nek.lu.se/publications/workpap/papers/wp15_36.pdf}},
  year         = {{2015}},
}