Scandinavian Working Papers in Economics

Working Papers,
Lund University, Department of Economics

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

Anders Anell (), Jens Dietrichson () and Lina Maria Ellegård ()
Additional contact information
Anders Anell: Department of Business Administration, Lund University
Jens Dietrichson: SFI - The Danish National Centre for Social Research
Lina Maria Ellegård: Department of Economics, Lund University, Postal: Department of Economics, School of Economics and Management, Lund University, Box 7082, S-220 07 Lund, Sweden

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

JEL-codes: D23; H73; I11; I18; J33; J38

42 pages, First version: December 15, 2015. Revised: June 29, 2016.

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