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Factors influencing antibiotic prescribing in China: An exploratory analysis


  • Reynolds, Lucy
  • McKee, Martin


Objectives China has very high rates of antibiotic resistance and a health care system that provides strong incentives for over-prescribing. This paper describes the findings of a qualitative study in a province of southern China that seeks to assess knowledge, attitudes, and practices in relation to the use of antibiotics.Methods Semi-structured interviews with patients and health workers at provincial, county, township, and village level. Interviews used four probes (common cold, cough, mild diarrhoea and tiredness) where antibiotics were not indicated, supplemented by questions on knowledge, attitudes, and practices. These data were supplemented by two focus groups, with medical students and pharmacists, and discussions with participants at a national conference on antibiotic use.Results Coughs and diarrhoea are almost universally treated with antibiotics, while the cold is normally treated with antivirals instead or as well. Many physicians are aware that the cold is usually self-limiting but believe that they can speed recovery and that they are responding to patient expectations. Most physicians and many patients are aware of the phenomenon of antibiotic resistance, although it is often seen as a property acquired by the patient and not the micro-organism. Physicians face financial incentives to prescribe, with profit splitting with pharmaceutical suppliers. Sales profits form a major part of a hospital's income. National guidance on use of antibiotics is fragmentary and incomplete.Conclusion The misuse of antibiotics poses considerable risks. Effective action will require a multi-faceted strategy including education, based on an understanding of existing beliefs, the replacement of perverse incentives with those promoting best practice, and investment in improved surveillance. Much of this will require action at national level.

Suggested Citation

  • Reynolds, Lucy & McKee, Martin, 2009. "Factors influencing antibiotic prescribing in China: An exploratory analysis," Health Policy, Elsevier, vol. 90(1), pages 32-36, April.
  • Handle: RePEc:eee:hepoli:v:90:y:2009:i:1:p:32-36

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    References listed on IDEAS

    1. Xu, Wenbo, 1995. "Flourishing health work in China," Social Science & Medicine, Elsevier, vol. 41(8), pages 1043-1045, October.
    2. Dong, Hengjin & Bogg, Lennart & Rehnberg, Clas & Diwan, Vinod, 1999. "Association between health insurance and antibiotics prescribing in four counties in rural China," Health Policy, Elsevier, vol. 48(1), pages 29-45, July.
    3. Zheng, Xiang & Hillier, Sheila, 1995. "The reforms of the Chinese health care system: County level changes: The Jiangxi study," Social Science & Medicine, Elsevier, vol. 41(8), pages 1057-1064, October.
    4. David Banta, H., 1990. "Medical technology in China," Health Policy, Elsevier, vol. 14(2), pages 127-137.
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    Cited by:

    1. He, Alex Jingwei, 2014. "The doctor–patient relationship, defensive medicine and overprescription in Chinese public hospitals: Evidence from a cross-sectional survey in Shenzhen city," Social Science & Medicine, Elsevier, vol. 123(C), pages 64-71.
    2. Cheo, Roland & Ge, Ge & Godager, Geir & Liu, Rugang & Wang, Qiqi & Wang, Jian, 2018. "The effect of a mystery shopper scheme on prescriptions in primary care," HERO On line Working Paper Series 2018:1, Oslo University, Health Economics Research Programme.
    3. Yang, Lianping & Liu, Chaojie & Ferrier, J. Adamm & Zhang, Xinping, 2015. "Organizational barriers associated with the implementation of national essential medicines policy: A cross-sectional study of township hospitals in China," Social Science & Medicine, Elsevier, vol. 145(C), pages 201-208.
    4. Xiaohong Li & Christopher Cochran & Jun Lu & Jay Shen & Chao Hao & Ying Wang & Mei Sun & Chengyue Li & Fengshui Chang & Mo Hao, 2015. "Understanding the shortage of village doctors in China and solutions under the policy of basic public health service equalization: evidence from Changzhou," International Journal of Health Planning and Management, Wiley Blackwell, vol. 30(1), pages 42-55, January.


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