Can the remuneration scheme of general practitioners affect their antibiotic prescription behaviour?

To reduce the risk of antibiotic resistance, it is recommended to use antibiotics restrictively. We hypothesize that, compared to salaried general practitioners (GPs), GPs paid by fee-for service (FFS) and capitation (CAP) may be more incentivized to prescribe antibiotics for respiratory tract infections (RTIs) due to the following. The prescription of antibiotics might be valued by the patients and perceived as high-quality care, allowing GPs to keep existing patients on their list and attract new ones. Moreover, it may be quicker and, therefore, more profitable for a GP to write a prescription than to negotiate alternative solutions with the patient. We find that the probability of antibiotic prescription for RTI for GPs remunerated by a mix of FFS and CAP was, in relative terms, 13-15 % higher than for salaried GPs. When antibiotics are prescribed, GPs paid by FFS and CAP had an 10-11 % higher probability of prescribing another antibiotic than the narrow-spectrum antibiotic, phenoxymethylpenicillin. The findings are consistent when analysing within-subject effects of the subset of GPs switching remuneration types. We did not find any strong and significant difference between FFS and fixed salary when studying the antibiotic prescription behaviour of locum GPs.