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Department of Economics, Lund University Working Papers, Department of Economics, Lund University

No 2015:36:
Can Pay-for-Performance to Primary Care Providers Stimulate Appropriate Use of Antibiotics?

Anders Anell (), Jens Dietrichson () and Lina Maria Ellegård ()

Abstract: Antibiotics resistance is a major threat to public health. We examine if pay-for-performance (P4P) to primary care providers stimulates appropriate prescription of antibiotics; specifically, if P4P induces a substitution of narrow-spectrum antibiotics for broad-spectrum antibiotics (which contribute more to resistance) in the treatment of children with respiratory tract infections (RTI). During 2006-2013, a subset of Swedish healthcare authorities introduced antibiotics-related P4P in their reimbursement schemes for care providers. We employ municipality-level data covering all purchases of RTI antibiotics in a difference-in-differences analysis, and find that P4P significantly increased the share of narrow-spectrum antibiotics. There were no signs that physicians tried to game the system by increasing overall antibiotics use.

Keywords: pay-for-performance; antibiotics resistance; primary care; (follow links to similar papers)

JEL-Codes: D23; H73; I11; I18; J33; J38; (follow links to similar papers)

42 pages, December 15, 2015, Revised June 29, 2016

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This paper is forthcoming as:
Anell, Anders, Jens Dietrichson and Lina Maria Ellegård, 'Can Pay-for-Performance to Primary Care Providers Stimulate Appropriate Use of Antibiotics?', Health Economics.



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