This paper studies a dynamic model of a fee-for-service healthcare system in which healthcare providers attract patients by prescribing antibiotics. Using antibiotics limits antibiotic-treatable infections, but fosters the growth of antibiotic-resistant infections. The paper demonstrates a ‘Goldilocks’ effect from provider competition. A perfectly competitive market for providers over-prescribes antibiotics because providers do not bear the cost of antibiotic-resistant infections. A patient monopolist under-prescribes antibiotics in order to increase the level of treatable infection. This is because while infection is a ‘bad’ for society, infection is a ‘good’ for a provider of antibiotics under a fee-for-service regime. Due to more moderate antibiotic use, oligopolistic competition can be the optimal decentralized market structure. The paper then demonstrates how the model can be used for policy analysis.

本文研究了按服务收费的医疗保健系统的动态模型，在该模型中，医疗保健提供者通过开抗生素来吸引患者。使用抗生素会限制抗生素可治疗的感染，但会促进抗生素耐药性感染的增长。该论文展示了供应商竞争的“金发姑娘”效应。供应商的完全竞争市场会过度开具抗生素处方，因为供应商不承担抗生素耐药性感染的成本。患者垄断者开具不足的抗生素处方，以增加可治疗感染的水平。这是因为虽然感染对社会来说是“坏事”，但对按服务收费的抗生素供应商来说，感染是“好事”。由于更温和的抗生素使用，寡头竞争可以成为最佳的分散市场结构。