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Scholarly Works (2 results)

  • Thesis
  • Peer Reviewed
UCLA Electronic Theses and Dissertations (2021)

Overuse of antibiotics and increases in antibiotic-resistant strains are a global health problem. To address this, the Ministry of Health, Welfare and Labour in Japan introduced several health policies: the National Action Plan on Antimicrobial Resistance in 2016; the financial incentives for not prescribing antibiotics in 2018; and the financial incentives for creating antimicrobial stewardship teams. This dissertation assessed the effects of the newly introduced health policies and current healthcare insurance systems on antibiotic and non-antibiotic prescription patterns and healthcare resource utilization using a nationally representative administrative database from 2012–2019. The quasi-experimental designs allowed to compare the changes in outcomes between the eligible and ineligible medical facilities or areas for the health policies. The studies found that the introduction of the National Action Plan and financial incentives for non-prescribing of antibiotics substantially reduced total and broad-spectrum antibiotics in outpatient settings. In contrast, the introduction of financial incentives for creating antimicrobial stewardship teams did not affect antibiotic use in inpatient settings. The free medical certificates and free prescription policy did not influence the outpatient antibiotic prescriptions but had effects on increases in non-antibiotic prescriptions and outpatient healthcare expenditures.The findings suggest that the National Action Plan and financial incentives for not prescribing antibiotics have successfully reduced antibiotic prescriptions, supporting the recent expansion of the age ranges for the financial incentives. Also, the findings infer the need for modifying the current health policies (incentives for creating antimicrobial stewardship teams and free medical certificates for children) to improve inpatient antibiotic prescriptions and outpatient non-antibiotic prescriptions.

    Cover page: The Effects of Changes in Health Policies on Antibiotic and non-Antibiotic Prescription Patterns and Healthcare Utilization in Japan
    • Article
    • Peer Reviewed
    UCLA Previously Published Works (2022)

    Background

    For addressing antibiotic overuse, Japan designed a health care policy in which eligible medical facilities could claim a financial reward when antibiotics were not prescribed for early-stage respiratory and gastrointestinal infections. The policy was introduced in a pilot manner in paediatric clinics in April 2018.

    Methods

    We conducted a quasi-experimental, propensity score-matched, difference-in-differences (DID) design to determine whether the nationwide financial incentives for appropriate non-prescribing of antibiotics as antimicrobial stewardship [800 JPY (≈7.3 US D) per case] were associated with changes in prescription patterns, including antibiotics, and health care use in routine paediatric health care settings at a national level. Data consisted of 9 253 261 cases of infectious diseases in 553 138 patients treated at 10 180 eligible or ineligible facilities.

    Results

    A total of 2959 eligible facilities claimed 316 770 cases for financial incentives and earned 253 million JPY (≈2.29 million USD). Compared with ineligible facilities, the introduction of financial incentives in the eligible facilities was associated with an excess reduction in antibiotic prescriptions [DID estimate, -228.6 days of therapy (DOTs) per 1000 cases (95% CI, -272.4 to -184.9), which corresponded to a relative reduction of 17.8% (95% CI, 14.8 to 20.7)]. The introduction was also associated with excess reductions in drugs for respiratory symptoms [DID estimates, -256.9 DOTs per 1000 cases (95% CI, -379.3 to -134.5)] and antihistamines [DID estimate, -198.5 DOTs per 1000 cases (95% CI, -282.1 to -114.9)]. There was no excess in out-of-hour visits [DID estimate, -4.43 events per 1000 cases (95% CI, -12.8 to 3.97)] or hospitalizations [DID estimate, -0.08 events per 1000 cases (95% CI, -0.48 to 0.31)].

    Conclusions

    Our findings suggest that financial incentives to medical facilities for not prescribing antibiotics were associated with reductions in prescriptions for antibiotics without adverse health care consequences. Japan's new health policy provided us with policy options for immediately reducing inappropriate antibiotic prescriptions by relatively small financial incentives.
      Cover page: The consequence of financial incentives for not prescribing antibiotics: a Japan's nationwide quasi-experiment.
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