An economic perspective on policy to reduce antimicrobial resistance
An economic perspective on policy to reduce antimicrobial resistance
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DOI：
10.1016/s0277-9536(97)00132-9
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发表时间：
1998-01-01
影响因子：
5.4
通讯作者：
Millar, MR
中科院分区：
文献类型：
--
作者：
Coast, J;Smith, RD;Millar, MR
在全球范围内，抗菌药的抗药性正在增加。这种耐药性至少在一定程度上与抗菌剂的高使用率有关。尽管人们的意识越来越强，但经济学家(以及更普遍的政策分析人士)对这个问题的关注很少。在本文中，抗菌素耐药性被概念化为与抗菌剂消费相关的负外部性，并被设定在与抗菌剂使用相关的成本和收益的更广泛的背景下。考虑到建立耐药和敏感微生物流行病学模型的能力极其有限，很难确定试图减少耐药性的总体影响。然而，为了这篇论文的目的，假设通过减少抗菌剂的使用来处理耐药性将带来积极的社会效益。传统上与环境经济学相关的三种政策选择(管制、许可和收费)与它们对阻力问题的潜在影响能力有关。英国S国家医疗服务体系的初级保健部门为本研究提供了背景。将这些政策简单地应用于医疗保健可能会出现问题，尤其是由于临床在适当时候开药的自由可能会减少，以及对医疗保健提供公平的渴望。这篇论文初步得出结论，许可证可以为抗菌素耐药性提供最好的政策回应，但需要注意的是，需要进行实证研究才能开发出最实用、最高效的体系。这项研究必须与所需的流行病学研究一起进行。(C)1998年由Elsevier Science Ltd.出版。保留所有权利。
Resistance to antimicrobial drugs is increasing worldwide. This resistance is, at least in part, associated with high antimicrobial usage. Despite increasing awareness,economists (and policy analysts more generally) have paid little attention to the problem. In this paper antimicrobial resistance is conceptualised as a negative externality associated with the consumption of antimicrobials and is set within the broader context of the costs and benefits associated with antimicrobial usage. It is difficult to determine the overall impact of attempting to reduce resistance, given the extremely limited ability to model the epidemiology of resistant and sensitive micro-organisms. It is assumed for the purposes of the paper, however, that dealing with resistance by reducting antimicrobial usage would lead to a positive societal benefit. Three policy options traditionally associated with environmental economics (regulation, permits and charges) are examined in relation to their potential ability to impact upon the problem of resistance. The primary care sector of the U.K.'s National Health Service provides the context for this examination. Simple application of these policies to health care is likely to be problematic, with difficulties resulting particularly from the potential reduction in clinical freedom to prescribe when appropriate, and from the desire for equity in health care provision. The paper tentatively concludes that permits could offer the best policy response to antimicrobial resistance, with the caveat that empirical research is needed to develop the most practical and efficient system. This research must be conducted alongside the required epidemiological research. (C) 1998 Published by Elsevier Science Ltd. All rights reserved.