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Antibiotic stewardship from a decision-making, behavioral economics, and incentive design perspective.
Applied Ergonomics ( IF 3.1 ) Pub Date : 2020-08-26 , DOI: 10.1016/j.apergo.2020.103242
Brendan Bettinger 1 , James C Benneyan 2 , Tannaz Mahootchi 3
Affiliation  

Antibiotic-resistant infections cause over 20 thousand deaths and $20 billion annually in the United States. Antibiotic prescribing decision making can be described as a “tragedy of the commons” behavioral economics problem, for which individual best interests affecting human decision-making lead to suboptimal societal antibiotic overuse. In 2015, the U.S. federal government announced a $1.2 billion National Action Plan to combat resistance and reduce antibiotic use by 20% in inpatient settings and 50% in outpatient settings by 2020. We develop and apply a behavioral economics model based on game theory and “tragedy of the commons” concepts to help illustrate why rational individuals may not practice ideal stewardship and how to potentially structure three specific alternate approaches to accomplish these objectives (collective cooperative management, usage taxes, resistance penalties), based on Ostrom's economic governance principles. Importantly, while each approach can effectively incentivize ideal stewardship, the latter two do so with 10–30% lower utility to all providers. Encouraging local or state-level self-managed cooperative stewardship programs thus is preferred to national taxes and penalties, in contrast with current trends and with similar implications in other countries.



中文翻译:

从决策、行为经济学和激励设计角度看抗生素管理。

在美国,抗生素耐药性感染每年导致 2 万多人死亡和 200 亿美元。抗生素处方决策可被描述为“公地悲剧”行为经济学问题,个人最大利益影响人类决策会导致次优的社会抗生素过度使用。2015 年,美国联邦政府宣布了一项 12 亿美元的国家行动计划,以对抗耐药性,到 2020 年将住院环境中的抗生素使用量减少 20%,门诊环境中的抗生素使用量减少 50%。我们开发并应用基于博弈论和“公地悲剧”概念的行为经济学模型,以帮助说明为什么理性的个人可能不会实践理想的管理,以及如何潜在地构建三种特定的替代方法来实现这些目标(集体合作管理、使用税收、抵抗惩罚),基于奥斯特罗姆的经济治理原则。重要的是,虽然每种方法都可以有效地激励理想的管理,但后两种方法对所有提供商的效用降低了 10-30%。因此,与目前的趋势和其他国家的类似影响相比,鼓励地方或州级自我管理的合作管理计划优于国家税收和罚款。经济治理原则。重要的是,虽然每种方法都可以有效地激励理想的管理,但后两种方法对所有提供商的效用降低了 10-30%。因此,与目前的趋势和其他国家的类似影响相比,鼓励地方或州级自我管理的合作管理计划优于国家税收和罚款。经济治理原则。重要的是,虽然每种方法都可以有效地激励理想的管理,但后两种方法对所有提供商的效用降低了 10-30%。因此,与目前的趋势和其他国家的类似影响相比,鼓励地方或州级自我管理的合作管理计划优于国家税收和罚款。

更新日期:2020-08-27
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