General practitioners’ type of remuneration and antibiotic prescriptions. An analysis of patient switches using nationwide registry data

BACKGROUND: General practitioners (GPs) play a crucial gatekeeping role in limiting inappropriate antibiotic use. Studies have found that activity-based remuneration of GPs, such as fee-for-service (FFS), is associated with increased antibiotic prescribing. The aim of this study is to compare changes in antibiotic use between patients that switch between GPs with different remuneration types. METHODS: = 508 088). We apply a difference-in-differences design to compare patients that switch between GPs with different remuneration types to patients that switch between GPs with similar remuneration types (FFS/Capitation versus salary remuneration). FINDINGS: Patients who switch to an FFS GP experience an increase in antibiotic use, whereas those who switch to a salaried GP show a decrease. Patients switching from a salaried GP to an FFS GP (compared with salaried-to-salaried switchers) experience a monthly increase of 85 defined daily doses (DDD) of antibiotics per 1 000 patients (SD = 20). Conversely, patients switching from an FFS GP to a salaried GP (compared with FFS-to-FFS switchers) reduce their monthly antibiotics use by 21 DDD per 1000 (SD =7). INTERPRETATION: Our study indicates that GPs' remuneration type affects patients' antibiotic use, with FFS/CAP remuneration being associated with increased use of antibiotics. This relationship might be mediated by differences in consultation frequency, and systematic selection of GPs may also contribute to the observed differences.