Competition in primary care and prescription of antibiotics in Norway

  • Yana Zykova The Arctic University of Norway (UiT)
Keywords: Antibiotic resistance, economic incentives, salary, fee-for-service, capitation, Herfindahl-Hirschman Index (HHI)

Abstract

Appropriate use of antibiotics is an important strategy to combat the problem of growing antibiotic resistance rates. In order to follow this strategy, it is important to understand the determinants of antibiotic use. We analyse the potential link between competition among general practitioners (GPs) measured with the Herfindahl-Hirshman index (HHI) and regional antibiotic consumption in Norway in 2015 and 2016. We use the data about antibiotic consumption expressed by the number of prescriptions of antibiotics for systemic use (J01) and by the number of antibiotics for respiratory tract infections (phenoxymethylpenicillin (J01CE02), doxycycline (J01AA02), amoxicillin (J01CA04) and macrolides (J01FA)) per 1000 inhabitants. We apply multiple regression analysis to the data mentioned above and control for socioeconomic characteristics of the municipalities. Our findings suggest that competition may contribute to about 37-80 additional antibiotic prescriptions per 1000 inhabitants per year and 23-46 additional prescriptions per 1000 inhabitants of antibiotics for respiratory tract infections. Moreover, our estimations suggest that antibiotic prescription is significantly related to the average number of consultations per patient, the average length of the patient list, travel time to a pharmacy, income, and the share of women.

References

1. Fleming-Dutra, K.E., Hersh, A.L., Shapiro, D.J., Bartoces, M., Enns, E.A., File, T.M., et al.: Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010-2011. Jama, 315(17), 1864–1873 (2016). doi:10.1001/jama.2016.4151.
2. Kann, I. C., Bjørn, E., Lurås, H.: Competition in general practice: prescriptions to the elderly in a list patient system. Journal of health economics, 29(5), 751-764 (2010). https://doi.org/10.1016/j.jhealeco.2010.07.004
3. Scott, A., Shiell, A.: Analysing the effect of competition on general practitioners' behaviour using a multilevel modelling framework. Health economics, 6(6), 577-588 (1997). https://doi.org/10.1002/(SICI)1099-1050(199711)6:6<577::AID-HEC291>3.0.CO;2-Y
4. Brekke, K. R., Holmås, T. H., Monstad, K., Straume, O. R.: Competition and physician behaviour: Does the competitive environment affect the propensity to issue sickness certificates?. Journal of health economics, 66, 117-135 (2019). https://doi.org/10.1016/j.jhealeco.2019.05.007
5. Avorn, J., Solomon, D.H.: Cultural and economic factors that (mis) shape antibiotic use: the nonpharmacologic basis of therapeutics. Annals of Internal Medicine, 133(2), 128-135 (2000). doi:10.7326/0003-4819-133-2-200007180-00012.
6. Ashworth, M., White, P., Jongsma, H., Schofield, P., Armstrong, D.: Antibiotic prescribing and patient satisfaction in primary care in England: cross-sectional analysis of national patient survey data and prescribing data. British Journal of General Practice, 66(642), e40-e46 (2016). https://doi.org/10.3399/bjgp15X688105.
7. Butler, C.C., Rollnick, S., Pill, R., Maggs-Rapport, F., Stott, N.: Understanding the culture of prescribing: qualitative study of general practitioners' and patients' perceptions of antibiotics for sore throats. Bmj, 317(7159), 637-642 (1998). https://doi.org/10.1136/bmj.317.7159.637.
8. Hamm, R.M., Hicks, R.J., Bemben, D.: Antibiotics and respiratory infections: are patients more satisfied when expectations are met? Journal of Family Practice, 43(1), 56–62 (1996).
9. Zgierska, A., Rabago, D., Miller, M.M.: Impact of patient satisfaction ratings on physicians and clinical care. Patient preference and adherence, 8, 437 (2014). doi:10.2147/PPA.S59077.
10. Fogelberg, S.: Effects of competition between healthcare providers on prescription of antibiotics. IFN Working Paper 949: Research Institute of Industrial Economics. (2013). http://www.ifn.se/wfiles/wp/wp949.pdf. Accessed 18 Nov 2020
11. Kwon, I., Jun, D.: Information disclosure and peer effects in the use of antibiotics. Journal of health economics, 42, 1-16 (2015). https://doi.org/10.1016/j.jhealeco.2014.10.008
12. Bennett D, Hung C‐L, Lauderdale T‐L.: Health Care Competition and Antibiotic Use in Taiwan. The Journal of Industrial Economics, 63, 371– 393 (2015). https://doi.org/10.1111/joie.12075
13. Klein, E. Y., Van Boeckel, T. P., Martinez, E. M., Pant, S., Gandra, S., Levin, S. A., Gossens, H., Laxminarayan, R.: Global increase and geographic convergence in antibiotic consumption between 2000 and 2015. Proceedings of the National Academy of Sciences, 115(15), E3463-E3470 (2018). https://doi.org/10.1073/pnas.1717295115
14. European centre for disease prevention and control, https://www.ecdc.europa.eu/en/publications-data/antimicrobial-resistance-surveillance-europe-2016. Accessed 18 Nov 2020
15. The Norwegian Medicines Agency (Legemiddelverket), https://legemiddelverket.no/english/about-us/the-norwegian-health-care-system-and-pharmaceutical-system. Accessed 18 Nov 2020
16. Aasland, O. G., Rosta, J., Nylenna, M.: Healthcare reforms and job satisfaction among doctors in Norway. Scandinavian journal of public health, 38(3), 253-258 (2010). https://doi.org/10.1177/1403494810364559
17. Ringard, A., Sagan, A., Sperre Saunes, I., Lindahl, A. K.: Norway: Health system review. Health Systems in Transition, 15(8), 1-162 (2013). Retrieved from https://apps.who.int/iris/bitstream/handle/10665/330299/HiT-15-8-2013-eng.pdf?sequence=5&isAllowed=y (accessed 18 November 2020).
18. Norwegian Institute of Public Health, http://khs.fhi.no/webview/. Accessed 18 Nov 2020
19. Filippini, M., Masiero, G., Moschetti, K.: Socioeconomic determinants of regional differences in outpatient antibiotic consumption: evidence from Switzerland. Health policy, 78(1), 77-92 (2006). https://doi.org/10.1016/j.healthpol.2005.09.009
20. Masiero, G., Filippini, M., Ferech, M., Goossens, H.: Socioeconomic determinants of outpatient antibiotic use in Europe. International journal of public health, 55(5), 469-478 (2010). https://doi.org/10.1007/s00038-010-0167-y
21. Matuz, M., Benko, R., Doro, P., Hajdu, E., Nagy, G., Nagy, E.,Monnet, D. L., Soos, G.: Regional variations in community consumption of antibiotics in Hungary, 1996–2003. British journal of clinical pharmacology, 61(1), 96-100 (2006). https://doi.org/10.1111/j.1365-2125.2005.02525.x
22. Norwegian Directorate of Health (Helsedirektoratet), https://reisetid.helsedirektoratet.no/felles#akuttutvalget. Accessed 18 Nov 2020.
23. Wilson, A. A., Crane, L. A., Barrett, P. H., Gonzales, R.: Public beliefs and use of antibiotics for acute respiratory illness. Journal of general internal medicine, 14(11), 658-662 (1999). https://doi.org/10.1046/j.1525-1497.1999.08118.x
24. Faber, M. S., Heckenbach, K., Velasco, E., Eckmanns, T.: Antibiotics for the common cold: expectations of Germany’s general population. Eurosurveillance, 15(35), 19655 (2010). https://doi.org/10.2807/ese.15.35.19655-en
25. You, J. H. S., Yau, B., Choi, K. C., Chau, C. T. S., Huang, Q. R., Lee, S. S.: Public knowledge, attitudes and behavior on antibiotic use: a telephone survey in Hong Kong. Infection, 36(2), 153-157 (2008). 10.1007/s15010-007-7214-5
26. Gjelstad, S., Straand, J., Dalen, I., Fetveit, A., Strøm, H., Lindbæk, M.: Do general practitioners’ consultation rates influence their prescribing patterns of antibiotics for acute respiratory tract infections? Journal of antimicrobial chemotherapy, 66(10), 2425-2433 (2011). https://doi.org/10.1093/jac/dkr295
Published
2020-11-22