ArticleInternational journal of epidemiology2022
The consequence of financial incentives for not prescribing antibiotics: a Japan's nationwide quasi-experiment.
Article in International journal of epidemiology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 14 papers, 1 of them a synthesis that pooled it.
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Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it, 32 citations in OpenAlex.
- Factors contributing to the variation in antibiotic prescribing among primary health care physicians: a systematic review.BMC primary care · 2024Pooled it
- Appropriateness of outpatient antibiotic prescriptions in acute-care hospitals in Japan: a cross-sectional study from 2016-22.JAC-antimicrobial resistance · 2026Article
- Long-term National Trends in Pediatric Oral Antibiotic Prescriptions in Japan, 2011-2022.JMA journal · 2026Article
- Reporting macrolide-resistantJournal of clinical microbiology · 2026Review
- Impact of National Policies Promoting Appropriate Antibiotic Use on Outpatient Prescriptions and Hospitalizations for Bacterial Complications of Acute Respiratory Infections in Japan: An Interrupted Time-Series Analysis.Open forum infectious diseases · 2026Article
- Unbeneficial effects of not prescribing antibiotics to pediatric patients with acute upper respiratory infection: a descriptive epidemiological study based on a large Japanese medical claim database.Journal of pharmaceutical health care and sciences · 2025Article
- What Are the Drivers Triggering Antimicrobial Resistance Emergence and Spread? Outlook from a One Health Perspective.Antibiotics (Basel, Switzerland) · 2025Review
- Association of patient, physician and visit characteristics with inappropriate antibiotic prescribing in Japanese primary care: a cross-sectional study.BMJ public health · 2025Article
- Impact of Education on Inappropriate Antibiotic Prescription for Respiratory Tract Infection Based on Physicians' Justifications: A Web-Based Survey in Japan.Antibiotics (Basel, Switzerland) · 2024Article
- Influencing Primary Care Antibiotic Prescription Behavior Using Financial Incentives.Production and operations management · 2024Article
- Quality improvement initiative to reduce URI-associated antibiotic prescriptions among adult primary care providers.BMJ open quality · 2024Article
- Surveillance of Antimicrobial Prescriptions in Community Pharmacies Located in Tokyo, Japan.Antibiotics (Basel, Switzerland) · 2023Article
- Reasons and trends in youth's suicide rates during the COVID-19 pandemic.The Lancet regional health. Western Pacific · 2022Article
- Exploration of Trends in Antimicrobial Use and Their Determinants Based on Dispensing Information Collected from Pharmacies throughout Japan: A First Report.Antibiotics (Basel, Switzerland) · 2022Article
Corrections and comments
- Erratum issued
Authors and funding
9 authors at 4 institutions in 2 countries.
Funding
Abstract
backgroundFor 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.
methodsWe 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.
resultsA 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)].
conclusionsOur 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.
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