Physician dispensing and antibiotic prescriptions

The regulation on prescribing and dispensing of antibiotics has a double purpose: to enhance access to antibiotic treatment and to reduce the inappropriate use of drugs. Nevertheless, incentives to dispensing physicians may lead to inefficiencies. We sketch a theoretical model of the market for antibiotic treatment and empirically investigate the impact of self-dispensing on the per capita outpatient antibiotic consumption using data from small geographic areas in Switzerland. We find evidence that a greater proportion of dispensing practices is associated with higher levels of antibiotic use. This suggests that health authorities have a margin to adjust economic incentives on dispensing practices in order to reduce antibiotic misuse.Physician dispensing, Antibiotic use

Small area variations and welfare loss in the use of antibiotics in the community

This paper seeks to explain local variations in the use of antibiotics in the community and to assess the welfare loss due to heterogeneous attitudes towards the risk of bacterial infections and resistance. Significant differences are observed in the per capita antibiotic consumption measured in defined daily doses per 1000 inhabitants (DID) across small geographic areas in Switzerland. A model is proposed in which antibiotic use varies according to the socioeconomic characteristics of the population, the incidence of infections, antibiotic price and local supply of health care. Quarterly wholesales data on outpatient antibiotics in 2002 were obtained from IHA-IMS Market Research and combined with WHO standardized doses to obtain DID. The paper finds that the most important determinants of variations in outpatient antibiotics use in the community are income, demographic structure of the population and local supply and price of antibiotic treatment. We estimated that unexplained variations may account for 11% of the total antibiotic spending in the community, thus leading to a €6ml loss per year.antibiotic use, small area variations, welfare loss

Dispensing practices and antibiotic use

The regulation on prescribing and dispensing of antibiotics has a double purpose: to enhance access to antibiotic treatment and to reduce the inappropriate use of drugs. Nevertheless, incentives to dispensing physicians may lead to inefficiencies. We sketch a theoretical model of the market for antibiotic treatment and empirically investigate the impact of self-dispensing on the per capita outpatient antibiotic consumption using data from small geographic areas in Switzerland. We find evidence that a greater proportion of dispensing practices is associated with higher levels of antibiotic use. This suggests that health authorities have a margin to adjust economic incentives on dispensing practices in order to reduce antibiotic misuse.Dispensing, Antibiotic use

Characteristics of demand for antibiotics in primary care: an almost ideal demand system approach

We model demand for different classes of antibiotics used for respiratory infections in outpatient care using a linear approximate almost ideal demand system approach. We compute elasticities to socioeconomic determinants of consumption and own- and cross- price elasticities between different groups of antibiotics. We find significant elasticities between newer/more expensive generations and older/less expensive generations of antibiotics. The larger use of more expensive antibiotics is also associated with the self-dispensing status of practices, ceteris paribus.Antibiotic use, Demand equations, Demand elasticities, Almost Ideal Model, Self-dispensing

Small area variations and welfare loss in the use of outpatient antibiotics

This article seeks to explain local variations in the use of antibiotics in the community and to assess the welfare loss due to heterogeneous attitudes towards the risk of bacterial resistance. Quarterly data on antibiotic sales from 240 small areas in Switzerland over the course of one year are used. An econometric ad-hoc model with spatial lags is proposed in which the demand for antibiotics varies according to the socioeconomic characteristics of the population, the incidence of infections, antibiotic price and local health care supply. Using residual variations we then evaluate the welfare loss due to varying antibiotic prescription styles. Significant differences are observed in the per capita antibiotic consumption across local areas. Individual income, the demographic structure of the population, physician density and the price of drugs are all relevant determinants. We estimate that unexplained variations may account for 12% of the total antibiotic spending in the community, thus leading to a ₠ 6.8 ml loss per year. Understanding the determinants of variations in outpatient antibiotic consumption may help to design more effective policies to counter the threat of bacterial resistance. Our estimate of the welfare loss due to heterogeneous attitudes towards antibiotic treatment is comparable to the expected cost of implementing measures to improve the dissemination of information on bacterial resistance among patients and doctor

Characteristics of demand for antibiotics in primary care: an almost ideal demand system approach

We model demand for different classes of antibiotics used for respiratory infections in outpatient care using a linear approximate almost ideal demand system approach. We compute elasticities to socioeconomic determinants of consumption and own- and cross- price elasticities between different groups of antibiotics. We find significant elasticities between newer/more expensive generations and older/less expensive generations of antibiotics. The larger use of more expensive antibiotics is also associated with the self-dispensing status of practices, ceteris paribus

Regional differences in outpatient antibiotic consumption in Switzerland

This paper investigates regional variations in outpatient antibiotic use and provides a first empirical analysis based on Swiss data. We compare Swiss antibiotic consumption with antibiotic use in other European countries and present descriptive statistics at cantonal level. Preliminary findings show that Switzerland exhibits relatively low levels of consumption. There are significant differences among cantons both in the per capita antibiotic sales and Defined Daily Doses per 1000 inhabitants per day (DID). Regression analysis suggests that demographic factors, density of pharmacies and medical practices, income and the incidence of infections are significantly related to antibiotic consumption

Potentially avoidable hospitalizations and socioeconomic status in Switzerland : A small area-level analysis

The Swiss healthcare system is well known for the quality of its healthcare and population health but also for its high cost, particularly regarding out-of-pocket expenses. We conduct the first national study on the association between socioeconomic status and access to community-based ambulatory care (CBAC). We analyze administrative and hospital discharge data at the small area level over a four-year time period (2014 – 2017). We develop a socioeconomic deprivation indicator and rely on a well-accepted indicator of potentially avoidable hospitalizations as a measure of access to CBAC. We estimate socioeconomic gradients at the national and cantonal levels with mixed effects models pooled over four years. We compare gradient estimates among specifications without control variables and those that include control variables for area geography and physician availability. We find that the most deprived area is associated with an excess of 2.80 potentially avoidable hospitalizations per 1,000 population (3.01 with control variables) compared to the least deprived area. We also find significant gradient variation across cantons with a difference of 5.40 (5.54 with control variables) between the smallest and largest canton gradients. Addressing broader social determinants of health, financial barriers to access, and strengthening CBAC services in targeted areas would likely reduce the observed gap