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


  • Lina Maria Ellegård
  • Jens Dietrichson
  • Anders Anell


Antibiotic resistance is a major threat to public health worldwide. As the healthcare sector's use of antibiotics is an important contributor to the development of resistance, it is crucial that physicians only prescribe antibiotics when needed and that they choose narrow‐spectrum antibiotics, which act on fewer bacteria types, when possible. Inappropriate use of antibiotics is nonetheless widespread, not least for respiratory tract infections (RTI), a common reason for antibiotics prescriptions. We examine if pay‐for‐performance (P4P) presents a way to influence primary care physicians' choice of antibiotics. During 2006–2013, 8 Swedish healthcare authorities adopted P4P to make physicians select narrow‐spectrum antibiotics more often in the treatment of children with RTI. Exploiting register data on all purchases of RTI antibiotics in a difference‐in‐differences analysis, we find that P4P significantly increased the share of narrow‐spectrum antibiotics. There are no signs that physicians gamed the system by issuing more prescriptions overall.

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  • Lina Maria Ellegård & Jens Dietrichson & Anders Anell, 2018. "Can pay‐for‐performance to primary care providers stimulate appropriate use of antibiotics?," Health Economics, John Wiley & Sons, Ltd., vol. 27(1), pages 39-54, January.
  • Handle: RePEc:wly:hlthec:v:27:y:2018:i:1:p:e39-e54
    DOI: 10.1002/hec.3535

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    Blog mentions

    As found by, the blog aggregator for Economics research:
    1. Paul Mitchell’s journal round-up for 17th July 2017
      by paulmitchell1 in The Academic Health Economists' Blog on 2017-07-17 16:00:07


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    2. Anell, Anders, 2019. "Performance management and audit & feedback to support learning and innovation – Theoretical review and implications for Swedish primary care," Papers in Innovation Studies 2019/11, Lund University, CIRCLE - Centre for Innovation Research.
    3. Anell, Anders & Dietrichson, Jens & Ellegård, Lina Maria & Kjellsson, Gustav, 2021. "Information, switching costs, and consumer choice: Evidence from two randomised field experiments in Swedish primary health care," Journal of Public Economics, Elsevier, vol. 196(C).
    4. Shan Huang & Hannes Ullrich, 2021. "Physician Effects in Antibiotic Prescribing: Evidence from Physician Exits," Discussion Papers of DIW Berlin 1958, DIW Berlin, German Institute for Economic Research.
    5. Anell, Anders & Dackehag, Margareta & Dietrichson, Jens & Ellegård, Lina Maria & Kjellsson, Gustav, 2022. "Better Off by Risk Adjustment? Socioeconomic Disparities in Care Utilization in Sweden Following a Payment Reform," Working Papers 2022:15, Lund University, Department of Economics, revised 12 Mar 2024.
    6. Lina Maria Ellegård, 2020. "Effects of pay-for-performance on prescription of hypertension drugs among public and private primary care providers in Sweden," International Journal of Health Economics and Management, Springer, vol. 20(3), pages 215-228, September.
    7. Blix, Mårten & Jeansson, Johanna, 2018. "Telemedicine and the Welfare State: The Swedish Experience," Working Paper Series 1238, Research Institute of Industrial Economics.
    8. Granlund, David & Zykova, Yana, 2020. "Can privatisation of primary care contribute to the spread of antibiotic resistance?," Umeå Economic Studies 977, Umeå University, Department of Economics.
    9. Shan Huang & Hannes Ullrich, 2023. "Provider effects in antibiotic prescribing: Evidence from physician exits," Berlin School of Economics Discussion Papers 0018, Berlin School of Economics.

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    More about this item

    JEL classification:

    • D23 - Microeconomics - - Production and Organizations - - - Organizational Behavior; Transaction Costs; Property Rights
    • H73 - Public Economics - - State and Local Government; Intergovernmental Relations - - - Interjurisdictional Differentials and Their Effects
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • J33 - Labor and Demographic Economics - - Wages, Compensation, and Labor Costs - - - Compensation Packages; Payment Methods
    • J38 - Labor and Demographic Economics - - Wages, Compensation, and Labor Costs - - - Public Policy


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