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

Summary, in English

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: Anders Anell; Lina Maria Ellegård; Jens Dietrichson
• Department/s: Department of Business Administration; Department of Economics
• Publishing year: 2015
• Language: English
• Publication/Series: Working Paper / Department of Economics, School of Economics and Management, Lund University
• Issue: 36
• Links: http://project.nek.lu.se/publications/workpap/papers/wp15_36.pdf
• Document type: Working paper
• Publisher: Department of Economics, Lund University
• Topic: Economics
• Keywords: pay-for-performance; antibiotics resistance; primary care
• Status: Published