CHE seminar - Influencing Primary Care Antibiotic Prescription Behavior Using Financial Incentives

Event details

Background: Antibiotic resistance is an ongoing public health crisis fuelled by overuse and misuse of antibiotics.  Various financial incentive programmes to reduce the rate of inappropriate antibiotic prescriptions have been implemented and studied empirically. However, there have not been analytical studies to evaluate payment model contract design features and the potential for payment models to impact diagnosis decision making. We examine the impact of action-based incentive payments on reducing inappropriate antibiotic prescriptions in primary care, where 30%–50% of antibiotic prescriptions are inappropriate. 

Results and Discussion: When there is no information asymmetry, an action-based incentive payment can coordinate care and achieve the first-best policy, decreasing the rate of inappropriate prescribing, even when incentive payments can affect the diagnosis behavior. However, when the diagnosis relies on additional objective testing, the first-best policy results in fewer inappropriate antibiotic prescriptions when the test has high specificity. Therefore, when an accurate technical diagnostic is available, a simple to implement action-based incentive payment can be effective in reducing inappropriate antibiotic prescribing. In the realistic setting where the provider’s opportunity cost is private information, financial incentive imposes a moral hazard on the provider’s prescription decision and an action-based incentive payment cannot eliminate inappropriate antibiotic prescribing. In these settings, the introduction of point of care diagnostics to aid in objective diagnostic criteria will reduce the unintended consequences of the contract.

Work with Salar Ghamat, Mojtaba Araghi, and Michael Silverman

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Professor Lauren Cipriano, Ivey Business School and Western University

Bio:  Lauren Cipriano is a Professor at the Ivey Business School and in the Department of Medicine and Department of Epidemiology & Biostatistics at Western University where she holds the Canada Research Chair in Healthcare Analytics, Management, and Policy. She earned her PhD in Management Science and Engineering and MS in Statistics at Stanford University. Lauren’s research interests focus on the application of statistics, decision analysis, operations research, and systems analysis to health policy problems. Previously, Lauren worked at the Institute for Technology Assessment at Massachusetts General Hospital. Lauren was the 2018 winner of the Dr. Maurice McGregor Award for Health Technology Assessment and Lauren is the Deputy Editor of Medical Decision Making and MDM Policy & Practice.