UCLA

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.