Summary
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.
KEYWORDS
antibiotic resistance, pay-for-performance, primary care

• Quantitative data - Quantitative data were used during the intervention

• Human - All activities regarding organisations and individuals involved in health products and services

• Healthcare delivery